Experience

MediVisa for medical claims settlement.

• Saudi Arabia
• Insurance
• 1 - 100 Employee

• Senior Claims Consultant

  • Mar 2016 - Present

  • Coordinate investigative efforts ensuring appropriateness. provide thorough review of contested claims. • Research problem claims accounts, reverse and reprocess as necessary. • Responsible to help work special projects with respect to overpayments. • Summarize claims in excess of authority and submit to manager for approval. • Create a estimate of damages for 1st and 3rd party material damage. • Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature. • Ensure that claims payments are issued in a timely and accurate manner. • Mentor and provide leadership to less experienced claims associates. • Assist with file reviews and file audits as needed. • Provide support to claim staff on client specific teams. • Inspect damages and prepare written estimates of repair or replacement. • Under limited supervision, responsible for making accurate decisions on specialty claim settlements. • Determine exposure, establish adequate reserves and make timely adjustments as required. • Partner with special investigation unit and subrogation to identify fraud and subrogation opportunities. • Apply appropriate interventions and follow up on identified projects. • Stay informed of changes in the collision repair industry as well as statutory and regulatory changes as they relate to material damage and communicate these changes to other claims personnel. • Take action independently, seek new opportunities, and strive to see projects to completion. • Assist the assistant director for administration with the preparation of financial statements and operating reports. • Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome. • Meet and communicate with claimants, legal counsel, and third-parties. • Timely and accurate filing and billing of all patient transactions (billing, invoices, and insurance claims). Show less



talabat

• United Arab Emirates
• Technology, Information and Internet
• 700 & Above Employee

• Customer Service Representative

  • Nov 2014 - Feb 2016

  Talabat.com subsidiary of Delivery Hero Gmbh - • Validating customers’ information and addresses. • Answering customer inquiries. • Following up all the enquiries, preparing forms and reports where necessary summarizing the coordination tasks implemented for any project for a new or current client. • Handling incoming calls and chats • Communicate & coordinate with other departments to answer all relevant customers' inquiries. • Following-up on customer complaints and requests to assure implementation. • Assisting in implementing the coordination strategy as set by the Sales manager including strategies for encouraging repeat business and up-selling. • Provide best service to customers to achieve highest level of customers' satisfaction. • Respect & apply company's vision & values and making a good public image for the company. Show less

• Claims Representative Specialist

  • Dec 2009 - Oct 2014

  Medi Visa Prim Health medical insurance - KSA. • Validating hospitals and customers’ information KSA claims. • Finalizing customers’ reports. • Making calls to set appointments with new clients. • Meeting with new clients to close deals. • Providing the required daily reports. Medi Visa Prim Health medical insurance - KSA. • Validating hospitals and customers’ information KSA claims. • Finalizing customers’ reports. • Making calls to set appointments with new clients. • Meeting with new clients to close deals. • Providing the required daily reports.