Abdellah Jubail
Reimbursement Medical Claims Assesor
Dubai,DU
Summary
Effective Medical Claims Assessor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
3
3
Languages
4
4
years of post-secondary education
5
5
years of professional experience
Work History
Assistant Pharmacist
O2 Pharmacy
Dubai, Dubai
02.2016 - 06.2017
- Communicated instructions to patients or caregivers.
- Counted and labeled prescriptions with correct item and quantity.
- Prepared bills for insurance companies.
- Set up and modified patient profiles in system to include current information such as medications and insurance details.
Medical Claims Processor (Direct Billing)
NEXtCARE TPA
Dubai, Dubai
07.2017 - 02.2019
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Paid or denied medical claims based upon established claims processing criteria.
- Reviewed provider coding information to report services and verify correctness.
- Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.
- Maintained confidentiality of patient finances, records and health statuses.
Reimbursement Medical Claims Asessor
NEXtCare TPA
Dubai, Dubai
03.2019 - Current
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Submitted electronic/paper claims documentation for timely filing.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Evaluated accuracy and quality of data entered into agency management system.
- Paid or denied medical claims based upon established claims processing criteria.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Managed efficient and accurate processing of invoices and check requests for [Number] of locations.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Utilized talents and expertise to complete on-time and accurate monthly closing processes, journal entries and accruals.
- Trained and mentored new team members and managers on accounts payable systems and policies to build cohesive groups and promote operational performance.
- Managed quality assurance program, including on-site evaluations, internal audits and customer surveys.
Education
Bachelor of Science - Pharmacy
Universidad De Zamboanga
Zamboanga City, Philippines 06.2010 - 04.2014
Skills
Claims investigation and research
undefinedNationality
Filipino
Timeline
Reimbursement Medical Claims Asessor
NEXtCare TPA
03.2019 - Current
Medical Claims Processor (Direct Billing)
NEXtCARE TPA
07.2017 - 02.2019
Assistant Pharmacist
O2 Pharmacy
02.2016 - 06.2017
Bachelor of Science - Pharmacy
Universidad De Zamboanga
06.2010 - 04.2014
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