Izeldien Fath Alrahman Hassan Ali

Accomplished Medical Claims Manager with a background in medicine, holding an M.B.B.S. degree and over a decade of diverse experience in clinical practice, insurance, and claims management. I possess a unique blend of medical expertise and managerial acumen, which allows me to effectively bridge the gap between healthcare providers and insurance entities. My career has been marked by a strong commitment to optimizing claims processes, ensuring regulatory compliance, and delivering exceptional service to clients. With a proven track record of leading teams, conducting thorough audits, and streamlining operations, I am dedicated to driving organizational growth and enhancing the quality of healthcare insurance services. Fluent in Arabic, English, and Russian, I bring a global perspective and a keen understanding of cross-cultural healthcare dynamics.

• Orientation course for house officer (the academy of Medicine and Technology)
• Certificates of permanent full registration (Sudan Medical Council)
• Basic Life Support Provider
• Expert in using Computer and essential software including office suite, AIMS, Pulse software and others

Dubai National Insurance and Reinsurance, Dubai, UAE
17/05/2017 – Present

In my role as Assistant Manager of Medical Claims, I am entrusted with overseeing the day-to-day operations of the claims department, ensuring that all processes are executed efficiently and in compliance with industry regulations. My responsibilities include:

• Team Leadership: Supervising and managing a dedicated claims team, fostering a collaborative environment that encourages high performance and continuous improvement.
• Claims Auditing: Conducting thorough audits of hospital and Third-Party Administrator (TPA) claim files to ensure accuracy, compliance, and alignment with company policies.
• Claims Settlement: Judiciously settling both reimbursement and network claims, ensuring that all approvals are obtained as per the established authority matrix.
• Process Optimization: Organizing and streamlining work procedures and systems to enhance operational efficiency and reduce turnaround times.
• Customer Service Excellence: Ensuring that customers receive top-quality service by addressing their concerns promptly and maintaining high standards of communication and care.
• Regulatory Compliance: Adhering to regulatory requirements, ensuring that all claims processing activities comply with local laws and industry standards.
• Claims Evaluation: Responsible for the evaluation and processing of reimbursement medical claims received from all TPAs, ensuring that only eligible services are approved and paid in accordance with policy terms.

Al-Buhaira National Insurance Company, UAE
25/04/2014 – 15/05/2017

In this role, I specialized in managing and assessing hazard insurance claims. My responsibilities included evaluating claims, ensuring compliance with policy terms, and coordinating with relevant stakeholders to facilitate timely and accurate settlements. I also played a key role in risk assessment and mitigation, helping the company minimize potential losses.

Neuron LLC, UAE
14/02/2013 – 21/04/2014

As a Medical Consultant in the Approval Section, I was responsible for reviewing and approving medical claims, ensuring that they met the necessary criteria for coverage. My role involved close collaboration with healthcare providers and insurers to facilitate efficient claims processing and resolve any discrepancies or issues that arose during the approval process.

AFP Surveillance Unit, Poliomyelitis Eradication Initiative Program, Expanded Program on Immunization, Sudan
01/05/2012 – 13/02/2013

In this capacity, I contributed to the global effort to eradicate poliomyelitis by assisting in the surveillance and monitoring of acute flaccid paralysis (AFP) cases. My duties included data collection, case investigation, and coordination with local and international health organizations to ensure the effective implementation of immunization campaigns.

King Fahad Specialized Hospital, KSA
31/03/2010 – 23/09/2011

During my tenure as a Resident Doctor and ER Resident, I gained extensive experience in emergency medicine, managing a wide range of acute and chronic conditions. I was responsible for providing immediate care to patients, performing diagnostic procedures, and coordinating with multidisciplinary teams to ensure comprehensive patient care.

King Fahad Specialized Hospital, Buraidah, Al Qassim Province, KSA
18/03/2009 – 31/03/2010

In this role, I served as an ER Resident, where I honed my skills in managing emergency cases, conducting initial patient assessments, and providing urgent care. My experience in this position laid the foundation for my expertise in handling high-pressure medical situations.

Prince Faisal Cancer Center, Buraidah, Al Qassim Province, KSA
11/07/2009 – 17/12/2009

As an ER Resident at the Prince Faisal Cancer Center, I was tasked with providing emergency medical care to oncology patients. My responsibilities included managing complications related to cancer treatment, coordinating with oncologists, and ensuring that patients received timely and appropriate interventions.

Omdurman Military Hospital, Department of Insurance Medical Approval Unit, Medical Claim Unit, Omdurman, Khartoum, Sudan
11/02/2008 – 11/03/2009

In this role, I was responsible for evaluating and processing medical claims for military personnel. My duties included assessing the validity of claims, ensuring compliance with insurance policies, and coordinating with healthcare providers to verify the necessity and appropriateness of treatments.

I am a highly motivated and dedicated medical professional with a robust background in both clinical and administrative roles. My career journey has allowed me to transition seamlessly from hands-on patient care to strategic management in the insurance industry. With a strong foundation in medicine, I have developed a deep understanding of healthcare systems, enabling me to effectively manage medical claims and ensure that they align with clinical standards and regulatory requirements. My experience spans a wide range of challenging roles, including clinical practice, medical consulting, and managerial positions, where I have consistently demonstrated creativity, leadership, and a commitment to delivering top-quality service. In my current role as a Medical Claims Manager, I leverage my clinical expertise and administrative acumen to optimize claims processing, enhance operational efficiency, and uphold the highest standards of service for both clients and the organization.

• Title: M.B.B.S.
• Date of Birth: 05/29/1980
• Gender: Male
• Nationality: Sudanese
• Marital Status: Married