Duoraid Jamal Salih AL-Khatib
Health Insurance Operations Management
Dubai
Summary
A medical doctor with more than 7 years of clinical experience followed by 15 years in health insurance dealing with medical claims & authorizations (IP mainly), experienced in different insurance rules and portfolios, well aware about the schedules of benefits & general exclusions for different insurance products. Medical claims expert having wide experience with submission claims, resubmission, reimbursement, dental & reconciliation claims. Expert in DRG billing system and adjudication processes. Deal with health providers to discuss issues of conflict & contribute with meetings to set the work guidelines & common understanding of work requirements. Also have experience in dealing with different regulatory bodies to discuss billing and adjudication rules changes, cost optimization initiatives, etc. More than 13 years’ experience in different leadership roles, always looking forward for improvement & highly ambitious to reach higher levels of professionalism and leadership. Results-driven VP with forward-thinking approach centered on company success and competitive growth. Demonstrated record of success in building successful teams and managing profitable operations.
Overview
25
25
years of professional experience
7
7
years of post-secondary education
Work History
Vice President - Case Management
National Health Insurance Company - Daman
Abu Dhabi
01.2022 - 02.2023
- Responsible for managing Homecare & LTC authorization, Inhouse CM & Onsite CM teams.
- Hired and managed employees to maximize productivity while training staff on best practices and protocols.
- Identified opportunities to improve business process flows and productivity.
- Established performance goals for department and provided methods for reaching milestones.
- Collaborated with senior management to develop strategic initiatives and long term goals.
- Demonstrated proficient leadership skills to motivate employees and build competent teams.
- Collaborated with legal, compliance and other professional teams to review and maintain compliance with regulations.
- Created succession plans to provide continuity of operations during leadership transitions.
- Managed financial, operational and human resources to optimize business performance.
Manager - Case Management
National Health Insurance Company - Daman
Abu Dhabi
06.2021 - 01.2022
- Responsible for Homecare & LTC authorization, Inhouse CM & Onsite CM.
- Maximized performance by monitoring daily activities and mentoring team members.
- Cross-trained existing employees to maximize team agility and performance.
- Managed and motivated employees to be productive and engaged in work.
- Defined clear targets and objectives and communicated to other team members.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Onboarded new employees with training and new hire documentation.
- Handled almost double workload with the same count of resources through process optimization and enhanced automation from < 10% to ~ 40%
Manager Claims
National Health Insurance Company - Daman
Abu Dhabi
07.2014 - 06.2021
- Responsible for managing IP, reimbursement, and dental claims teams.
- Determined proper course of action for claims processing.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Documented and communicated timely claims information while supporting accurate outcomes.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Delivered exceptional customer service to policyholders by collaborating with sales teams and patiently listening to issues and worked on resolutions.
- Championed health insurance claims process by providing expert knowledge and analytical skills to optimize process with lean techniques and improved processing productivity.
- Mastered the DRG billing and adjudication rules from time of inception in Abu Dhabi and built strong teams with good training and command on DRG claims adjudication.
- Enhanced IP claims automation figures to reach ~ 50% and maximized team outcomes with > 30% increase in processing capacity with competent quality maintained at all times. accuracy above 99%
- Played active role in implementation and finalization of the DRG billing system in Dubai in collaboration with the regulator and other stakeholders.
Senior Supervisor - Claims
National Health Insurance Company-Daman
Abu Dhabi
01.2012 - 09.2017
- Coordinated, supervised and evaluated work of subordinates and reallocated staff and resources to meet performance requirements.
- Identified underperforming areas and implemented effective process improvements.
- Recruited, hired and trained staff and provided ongoing feedback and performance evaluations for development.
- Fostered effective communication by providing constructive feedback and sharing knowledge across business lines.
- Maximized personal competency through continuous professional development.
- Trained new hires and provided positive reinforcement and helpful feedback that boosted morale and efficiency within department.
- Provided feedback, training and skill development to staff to improve accuracy, productivity and quality.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Achieved results by working with staff to meet established targets.
- Started IP claims automation process for the first time focusing on DRG claims automation.
- Boosted team productivity by proper processing analysis to set fair targets with special focus of quality. Productivity improved by > 20 - 30%
- Maintained highest level of adjudication quality for IP claims teams with accuracy rate of > 99%.
Medical Encoding Supervisor - Claims
National Health Insurance Company-Daman
Abu Dhabi
01.2009 - 01.2012
- Developed and maintained courteous and effective working relationships.
- Developed strong organizational and communication skills through coursework and volunteer activities.
- Cultivated interpersonal skills by building positive relationships with others.
- Managed time efficiently in order to complete all tasks within deadlines.
- Identified issues, analyzed information and provided solutions to problems.
- Skilled at working independently and collaboratively in team environment.
- Self-motivated, with strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Demonstrated high level of initiative and creativity while tackling difficult tasks.
Senior Medical Review Officer - Claims
National Health Insurance Company-Daman
Abu Dhabi
01.2008 - 01.2009
- Processing Medical IP Claims
- Reviewing IP claims and providing feedback to junior colleagues for enhancement
- Deputizing supervisor in specific tasks
- Responsible for claims batch completion and maintaining processing TAT
Medical Review Officer
National Health Insurance Company
Abu Dhabi
01.2007 - 01.2008
- Processing IP claims with high performance, productivity and quality
- Training new joiners
- Highlighting billing trends
GP Doctor & Manager
Different Medical centers and hospitals in Yemen
03.2004 - 05.2007
GP Doctor - Medical Rotation
Different hospitals at different cities in Iraq
10.2000 - 02.2004
Pregraduate training at AL-Wasity Hospital
06.1998 - 09.1998
- For reconstructive surgery under Dr Ala Bashir supervision
Education
Diploma - Diabetes Mellitus
Middle Sex University
London, UK 01.2018 - 10.2018
M.B.Ch.B - Medicine And General Surgery
Al-Mustansiriya University, College of Medicine
Baghdad, Iraq 10.1994 - 10.2000
Skills
Highly oriented for dealing with Med Next & Microsoft Oracle system for claims management and automation
Accomplishments
Performance management training course
Supervisory skills training courses (Level 1 & 2)
Supervisory presentation skills
Employee observer & interviewer
Setting & Managing Targets
Managing upwards with influence
SAS Enterprise Guide 1 (Querying & Reporting)
MS office training course
English language training course
Organizational Leadership training
Iraqi Public Leadership Program (IPLP6)
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Allah loves when one of you does a job, to master it
Prophet Mohammed PBUH
Timeline
Vice President - Case Management
National Health Insurance Company - Daman
01.2022 - 02.2023
Manager - Case Management
National Health Insurance Company - Daman
06.2021 - 01.2022
Diploma - Diabetes Mellitus
Middle Sex University
01.2018 - 10.2018
Manager Claims
National Health Insurance Company - Daman
07.2014 - 06.2021
Senior Supervisor - Claims
National Health Insurance Company-Daman
01.2012 - 09.2017
Medical Encoding Supervisor - Claims
National Health Insurance Company-Daman
01.2009 - 01.2012
Senior Medical Review Officer - Claims
National Health Insurance Company-Daman
01.2008 - 01.2009
Medical Review Officer
National Health Insurance Company
01.2007 - 01.2008
GP Doctor & Manager
Different Medical centers and hospitals in Yemen
03.2004 - 05.2007
GP Doctor - Medical Rotation
Different hospitals at different cities in Iraq
10.2000 - 02.2004
Pregraduate training at AL-Wasity Hospital
06.1998 - 09.1998
M.B.Ch.B - Medicine And General Surgery
Al-Mustansiriya University, College of Medicine
10.1994 - 10.2000
Conferences & Seminars:
Different CME seminars related to Hypertension, Diabetes Mellitus, Gastroenterology, etc.
ICD10 & PSC procedures coding seminar (HAAD)
Inpatient Evaluation & Management seminar (HAAD)
1st Healthcare Insurance Fraud Middle east Forum
DRG HCPCS ADD-ON conference (HAAD)
Middle Managers Online Muster (3 days online conference)
Global Leadership Forum - Robin Sharma - Palazzo Versace
References
1. Dr. Michael Bitzer (Cheif Executive Officer / National Health Insurance Company - Daman)
2. Dr. Ali Anees (Executive Director Government Affairs / National Health Insurance Company - Daman)
3. Dr. Aziz Ustunel (Director Authorization & Case Management / National Health Insurance Company - Daman)
4. Dr. Klaus Boecker (Chief Medical & Operations Officer / National Health Insurance Company - Daman)
5. Dr. Abduljaleel Al-Khazraji (Cardiologist / Heart Beat Medical Centre / Abu Dhabi)
6. Dr. Husein Alwan Al Hilli (Internal Medicine / Dar Al-Shifa Hospital / Abu Dhabi).
7. Dr. Jawad H Twaij (Orthopaedic Surgeon / Dar Al-Shifa Hospital / Abu Dhabi).
8. Dr. Mohammed Khalil Al-Daheri (Urologist / Yas Clinic / Abu Dhabi).
9. Dr. Sinan AL-Azawy (Orthopaedic Surgeon) / Iraq - Baghdad.
10.Dr. Ahmed AL-Azawy (Oncology) / Sweden
11.Dr. Usama Nihad Refa`at (Urologist) / Iraq - Baghdad.
12.Dr. Raysan Al-Fayadh (General Surgery) / Iraq - Baghdad.
13.Prof. Dr. Najmiddin Al-Roznamjy (Paediatrician) / Iraq - Baghdad.
15.Dr. Husam Abdulkarim AL-Rubaiee (General Surgeon) / Iraq - Baghdad.
Conferences & Seminars
Different CME seminars related to Hypertension, Diabetes Mellitus, Gastroenterology, etc.
ICD10 & PSC procedures coding seminar (HAAD)
Inpatient Evaluation & Management seminar (HAAD)
1st Healthcare Insurance Fraud Middle east Forum
DRG HCPCS ADD-ON conference (HAAD)
Middle Managers Online Muster (3 days online conference)
Global Leadership Forum - Robin Sharma - Palazzo Versace
References
1. Dr. Michael Bitzer (Cheif Executive Officer / National Health Insurance Company - Daman)
2. Dr. Ali Anees (Executive Director Government Affairs / National Health Insurance Company - Daman)
3. Dr. Aziz Ustunel (Director Authorization & Case Management / National Health Insurance Company - Daman)
4. Dr. Klaus Boecker (Chief Medical & Operations Officer / National Health Insurance Company - Daman)
5. Dr. Abduljaleel Al-Khazraji (Cardiologist / Heart Beat Medical Centre / Abu Dhabi)
6. Dr. Husein Alwan Al Hilli (Internal Medicine / Dar Al-Shifa Hospital / Abu Dhabi).
7. Dr. Jawad H Twaij (Orthopaedic Surgeon / Dar Al-Shifa Hospital / Abu Dhabi).
8. Dr. Mohammed Khalil Al-Daheri (Urologist / Yas Clinic / Abu Dhabi).
9. Dr. Sinan AL-Azawy (Orthopaedic Surgeon) / Iraq - Baghdad.
10.Dr. Ahmed AL-Azawy (Oncology) / Sweden
11.Dr. Usama Nihad Refa`at (Urologist) / Iraq - Baghdad.
12.Dr. Raysan Al-Fayadh (General Surgery) / Iraq - Baghdad.
13.Prof. Dr. Najmiddin Al-Roznamjy (Paediatrician) / Iraq - Baghdad.
15.Dr. Husam Abdulkarim AL-Rubaiee (General Surgeon) / Iraq - Baghdad.
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