Jabir Ebrahim
Dubai,United Arab Emirates
Summary
With 4 years of experience in the TPA, I am a dependable and professional medical claim processor. Possess a strong track record of analyzing and processing claims in the agreed TAT and making decisions based on the TOB wording and DHA/DOH guidelines. My expertise in both the medical and insurance industries and terminologies, as well as my accurate coding abilities, allow me to meet targets. Providing high levels of customer service to future clients. Currently, employed as an Officer Health Claims at Inayah TPA(NLGIC).
Overview
8
8
years of professional experience
6
6
years of post-secondary education
Work History
Approval officer
Inayah TPA
Dubai, UAE
02.2023 - Current
- Evaluate claims (Network & Non-Network), provide authorizations for insured (in-patient & outpatient) and handle calls relating to medical cases efficiently.
- Manage queries from providers, Insurance Companies, Brokers and Insured members relating to pre-approval decisions, evaluation and administration.
- Provide medical guidance to the Claims Department staff and assistance in ICD coding, CPT procedure coding, 3M calculations & outlier, inlier DRG calculations.
- Manage Routine daily claims
- Attend calls and emails from Provider, insurance companies
- Increase efficiency, minimizes errors and administration time
- Takes decisions on high cost and complicated case based on standard operating procedure
- Coordinates workflow and meet deadlines
- Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.
- Client Management to investigate on claims in order to minimize fraud and abuse.
- Case management like Second medical opinion & Co-ordinated with members for home country transfer.
- Support claims, pre-approvals and customer support teams across medical and administrative operations to ensure they are operated effectively within the MB team thereby ensuring consistency. Work with the Manager to identify and monitor quality and establish problem areas and implement corrective action.
- Compile feedback from various sources thereby measuring external medical providers and healthcare benefits, documenting and investigating to seek recommendations for quality improvements
Medical officer
Medi Assist
Banglore, India
09.2020 - 11.2022
- Manage daily claims administration work of review and processing of claims in line with scope of coverage
- Ensure accuracy and consistency of data
- Forward approved claims once processed to PIC
- Work in accordance with defined SOP
- Work with high efficiency , minimizing errors and administration time to achieve monthly deadlines
Dentist
Shakira Dental Clinic
Kasargod, India
10.2016 - 07.2020
- Performed regular teeth cleanings with minimal discomfort for patients.
- Communicated clearly with patients about their treatment plans and aftercare instructions; fostered trust and compliance.
Education
Bachelor's degree - Dentistry
Century Dental College
Poinachi 10.2008 - 03.2015
Skills
- Informed decision making
- Coding and billing experience
- Patient and persistent
- Knowledge of insurance policies
- Medical coding familiarity
- Medical terminology familiarity
- Document verification
- Negotiating settlements
- Fraud detection
- Customer Service
Languages
English
Advanced
Hindi
Advanced
Malayalam
Native
Arabic
Beginner
Affiliations
- Running, Volunteer Activity
Accomplishments
*Nominated For Golden Visa under Humanitarian pioneer category
*Won Medal in 21, 10 KM running event
Timeline
Approval officer
Inayah TPA
02.2023 - Current
Medical officer
Medi Assist
09.2020 - 11.2022
Dentist
Shakira Dental Clinic
10.2016 - 07.2020
Bachelor's degree - Dentistry
Century Dental College
10.2008 - 03.2015
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