Experience

NAS Administration Services

• United Arab Emirates
• Insurance
• 200 - 300 Employee

• Policy Management Executive

  • Jul 2021 - Present



Nextcare

• United Arab Emirates
• Insurance
• 700 & Above Employee

• Senior Network Administrator

  • Aug 2016 - Dec 2020

  • SME on Project Testing and implementation in the System: Collaborating with direct manager, project manager, other involved SME on the project requirements. • Upload final price list on TATSH after being revised and approved by Procurement. • Upload and manage approved standard codes in the system (DDC, DoH Drug). • Generate report in the system for client’s request • Generate back-end data for analysis and take necessary action. • Maintain the correct Network data on the system to ensure our members/clients direct access at health Providers around the world. • Tracking tickets and managing the distribution to team members, ensuring proper follow-up of the task and monitoring the daily request • Providing weekly reports to the Manager and daily updates on priority matters. Show less



Accenture

• Ireland
• Business Consulting and Services
• 700 & Above Employee

• Claims Process Expert

  • Jan 2012 - May 2016

  Technician • Support the team by answering their inquiries regarding the process of the claims (SME). • Facilitates training for operators and examiners and maintain knowledge on all technical aspects, resolve issue and perform correction in every transaction when necessary. • Act as a substitute Team Leader of the team and handle the team’s concerns ad issues when Team Lead is not around or out of office. • Obtaining claims data from insurer and preparing claims report. Examiner • Processes medical claims and assure proper payment in accordance with the benefit plan. Provide customer service for plan benefits, provider networks and available services. • Validates the information used/entered on all life claims from patient information to payment. • Coordinating with medical providers for the verification of documents. Following up with insurers for settlement. • Identified and resolved potential billing errors with medical service providers which resulted in cost savings. Processor • Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures. • Review claims thoroughly to ensure that there is no missing, incomplete or incorrect information processed. • Process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements. • Maintain current knowledge of assigned plan(s) and effectively apply this knowledge in the processing of claims and providing customer service. Show less