Abubaker Mohammed
Lead medical insurance -Operations Officer
Dubai
Summary
Proven achiever in the insurance sector, particularly with Cigna Global Health Benefits US based and Local Insurance & TPAs, where I spearheaded initiatives that significantly enhanced claim processing efficiency and compliance and maintain quality of Service. Expert in underwriting and adept at fostering client relations, my critical thinking skills have consistently driven improvements in service quality and operational productivity. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
7
7
years of professional experience
Work History
Senior Medical Insurance Specialist
Cigna Global Health Benefits
01.2021 - Current
- leading the floor and review the daily workflow monitoring and reports and analyzed the productivity,quality and adherence, with developmental feedbacks and improvement plans.
- prepare schedules ( shifts, leaves,overtime) and training of new joiners.
- Handling escalations and complaints, with root cause analysis.
- Implemented efficient workflows within the department, leading to a reduction in processing time for each claim submitted.
- Collaborated with medical staff to obtain necessary documentation for accurate claim submissions.
- Consistently exceeded performance benchmarks, processing a high volume of claims accurately within designated timeframes.
- Served as a reliable resource for colleagues, sharing expertise on industry trends, changes in coding practices, or updates to payer requirements as needed.
- Enhanced data accuracy by meticulously updating patient records and insurance information in the system.
- Maintained compliance with industry regulations by staying updated on coding changes and guidelines.
- Assisted management in developing policies and procedures for streamlined billing processes, ensuring accuracy and compliance across the department.
Claims Officer
NextCare
03.2019 - 12.2020
- Minimized fraudulent claims by conducting thorough investigations and collaborating with law enforcement agencies.
- Expedited claim resolution with prompt negotiation, evaluation, and settlement of claim amounts.
- Negotiated fair settlements with policyholders while maintaining positive relationships between the company and clients involved in disputes.
- Continually updated knowledge on industry-specific regulations, ensuring compliance and maintaining a high standard of professionalism in interactions with clients.
- Maintained compliance with regulatory requirements by staying current on industry changes and updating policies accordingly.
- Improved interdepartmental communication to expedite claims processing and foster a collaborative work environment.
- Implemented innovative strategies for reducing claim cycle time without compromising quality or accuracy of decisions made.
- Prepared comprehensive reports for upper management detailing key findings from investigations into complex claim cases.
- Managed high caseload efficiently, prioritizing tasks based on urgency and importance to meet deadlines consistently.
- Processed and recorded new policies and claims.
Administration & Production/Medical Business Associate
Salama Islamic Arab Insurance
06.2017 - 01.2019
- Supported marketing efforts by developing promotional materials for upcoming events and educational opportunities within the practice.
- Actively participated in continuing education opportunities relevant to my role as Medical Business Associate.
- Assisted in the implementation of new billing software, resulting in a more accurate and efficient billing process.
- Assisted in the development of staff training materials, increasing overall competency levels among team members in key areas such as HIPAA compliance and infection control protocols.
- Managed patient referrals efficiently by tracking referral status from initiation through completion while providing necessary support documents to specialists when required.
- Managed scheduling for multiple healthcare providers, ensuring optimal patient flow and minimizing wait times.
- Contributed to successful accreditation reviews by consistently adhering to established policies and procedures regarding documentation standards.
- Conducted regular audits of billing processes to identify discrepancies or potential errors, resulting in increased accuracy rates.
Education
Bachelor of Science - Medical Pathology
Om Durman Islamic University
Sudan 04.2001 -
Skills
Account Management
Customers & Quality service Orientation
Critical thinking and decision making skills
Marketing & presentation Skills
Underwriting Knowledge
medical and Insurance market knowledge
conflict management
Insurance claims processing
Client Relations
Analytical Skills
Customer Account Review
Languages
Arabic
Advanced (C1)
English
Advanced (C1)
Timeline
Senior Medical Insurance Specialist
Cigna Global Health Benefits
01.2021 - Current
Claims Officer
NextCare
03.2019 - 12.2020
Administration & Production/Medical Business Associate
Salama Islamic Arab Insurance
06.2017 - 01.2019
Bachelor of Science - Medical Pathology
Om Durman Islamic University
04.2001 -
Similar Profiles
KRISTEN AGUILARKRISTEN AGUILAR
Customer Service Senior Supervisor at Cigna Global Health BenefitsCustomer Service Senior Supervisor at Cigna Global Health Benefits
Cynthia SalinasCynthia Salinas
Client Advocate/Case Management at Cigna Global Health BenefitsClient Advocate/Case Management at Cigna Global Health Benefits
Michelle NguyenMichelle Nguyen
Senior Operations Manager - CS&O at Cigna Global Health BenefitsSenior Operations Manager - CS&O at Cigna Global Health Benefits
MOHAMMED ANASMOHAMMED ANAS
Freelancer at Stefab.comFreelancer at Stefab.com
ERICK SAIMON MMBAGAERICK SAIMON MMBAGA
Ramp Operations Team Leader at Dnata, The Emirates GroupRamp Operations Team Leader at Dnata, The Emirates Group