JOHUR AHMED BORBHUIYA
Dubai
Summary
Accomplished Senior Claims Officer at Cigna-neuron, adept in claims analysis and problem-solving, enhanced processing efficiency while ensuring accuracy. Skilled in investigative techniques and fostering team collaboration, I led initiatives that significantly improved customer satisfaction. My strategic approach and analytical skills drove continuous improvement, marking notable achievements in the insurance sector.
Overview
9
9
years of professional experience
Work History
Senior Claims Office -PBM
Cigna-neuron
Dubai
06.2023 - Current
- Reviewed and processed high-volume of complex insurance claims to ensure timely resolution.
- Analyzed customer complaints and provided appropriate solutions to resolve disputes.
- Developed strategies to reduce processing time for claims while maintaining accuracy.
- Investigated discrepancies in documents presented by claimants or providers.
- Generated reports summarizing claim details including dates of service, payments made.
- Collaborated with underwriters to review policy provisions for accuracy.
- Participated in meetings with stakeholders to discuss current trends in the industry and develop new initiatives for improvement.
Associate Pre Authorization
Sukoon insurance PSC
Dubai
07.2022 - 06.2024
- Responsible for providing pre authorization to all network providers within UAE, such as OUT-PATIENT / OPTICAL / DENTAL / PHARMACY, for all eligible insured members
- Responsible for approval of high valued medications and biologics as per policy and FDA guidelines upto 45k AED
- Interacting with health care providers, brokers and policy holders to ensure highest standard of customer service
- Implement cost management strategies through second medical opinion & home country treatment option
- Training the new Joiner about pharmacy approval and protocols of PBM/medblocx system
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Medical case coordinator executive
National general insurance PJSC
Dubai
03.2018 - 06.2022
- Responsible for pre-authorization to all network providers within UAE, who need any medical services, such as: IN- PATIENT / OUT-PATIENT / OPTICAL / DENTAL / PHARMACY, for all eligible members of NGI-Healthnet members
- Processing E claims/ PBM claims by co-relating diagnosis with procedures, tests, and prescribed medicines as per policy
- Processing of payment at the end of every month for all OP network pharmacies and OP clinics as per policy
- Responsible for approval of high valued medications and biologic upto the limit of 30k AED
- Responsible for screening the DHA Drug update every month
- Leading entire pharmacy approvals and all medication related transactions within the NGI claims department
- Responsible for discount negotiation with pharmacies specifically for high cost drugs/biologic
- Dealing with Axios International as a part of cost containment and patient support for co payment
Pharmacist trainee
Supercare pharmacy
Dubai
10.2015 - 02.2018
- Dispensing prescription medications and OTC medications
- Complies with local rules and regulations regarding pharmacy activities, including but not limited to dispensing, labeling and delivery of medications and other pharmaceutical supplies
- Dealing with almost all the major health insurance companies of UAE and solving queries if there is any rejection from insurance or TPA
- Developed and implemented an assessment system that evaluated trainee performance and improved quality control
Territory sales manager
Magnus health India
Guwahati
06.2015 - 09.2015
- Managing entire NE region of India for Radio contrast business of company mainly oral contrast and inject-able contrast
- Trained and mentored sales representatives on effective sales techniques, resulting in an increase in sales closures by 20%
- Managed a team of sales representatives, leading to a 10% increase in sales
- Utilized sales techniques and strategies to build customer relationships and close sales
Education
Bachelor of Pharmacy -
Assam University
India05.2015
Skills
- Investigative techniques
- Claims investigation
- Claims analysis
- Problem-solving
- Investigation management
- Continuous improvement
- Data interpretation
- Analytical skills
- Multitasking
- Verbal and written communication
- Fraud identification
- Team collaboration
- Critical thinking
Hobbies and Interests
- Driving
- Hiking
- Swimming
Languages
English & Hindi : Highly proficient, Highly proficient, Very good command
References
Dr Abdul Waheed, National General insurance PJSC, Dubai, Dubai, United Arab Emirates, abdul.hafiz@ngiuae.com, 0522337917
Personal Information
- Nationality: Indian
- Driving License: UAE driving license
Timeline
Senior Claims Office -PBM
Cigna-neuron
06.2023 - Current
Associate Pre Authorization
Sukoon insurance PSC
07.2022 - 06.2024
Medical case coordinator executive
National general insurance PJSC
03.2018 - 06.2022
Pharmacist trainee
Supercare pharmacy
10.2015 - 02.2018
Territory sales manager
Magnus health India
06.2015 - 09.2015
Bachelor of Pharmacy -
Assam University
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