Kaltoum Djama Ali
Abu Dhabi,United Arab Emirates
Summary
Healthcare Project Specialist and Managed Care Expert with a proven record in designing and executing technology-driven initiatives to enhance healthcare services and strategies. Skilled in healthcare models, project management, data analysis and team leadership with expertise in clinical coding, negotiation and contract management. Experienced in conducting detailed clinical and financial analyses to support strategic decision-making, leveraging insights to deliver impactful results. Recognized as a proactive leader with strong communication skills, committed to continuous professional development and driving innovation in healthcare delivery
Overview
13
13
years of professional experience
1
1
Certification
Work history
Project Lead, Corporate Social Responsibility
PureHealth Holdings
09.2024 - 09.2025
- Led and manage strategic CSR projects ensuring their timely execution in alignment with corporate objectives and stakeholder expectations such as Barakatna Project.
- Cultivate and strengthen relationships with VIP and government stakeholders ensuring sustained engagement and active support throughout project execution.
- Analyzed emerging trends and identified opportunities to develop impactful CSR initiatives that enhance corporate sustainability and address stakeholder expectations.
- Established reporting mechanism and delivered comprehensive reports to senior leadership, showcasing project progress, key outcomes and financial impact.
- Represent the organization at prestigious CSR events and meetings ensuring effective communication with private and government stakeholders.
- Performed assessments on CSR initiatives to measure impact and identify areas for improvement and innovation.
Assistant Manager, Domestic Contracting
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2024 - 09.2024
- Established strategic partnerships with key policyholders to optimize contract negotiations and service delivery.
- Led cross-functional teams to streamline contract management processes and ensure compliance.
- Facilitated training sessions for junior staff on domestic contracting policies and procedures.
- Analyzed market trends to identify cost-saving opportunities and operational efficiencies within contracting framework.
Specialist, Domestic Contracting
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2022 - 01.2024
- Managed key provider groups and policyholders to enhance collaboration.
- Optimized processes to increase effectiveness of healthcare payment models.
- Provided essential support as deputy manager, ensuring team efficiency.
- Handled complex cases for key clients in the emirate of Abu Dhabi, ensuring timely resolutions.
- Customized medical services for clients to reduce overall medical expenses.
- Conducted regular assessments of policy performance to identify improvement areas.
Senior Provider Relations Officer
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2019 - 01.2022
- Conduct detailed financial analyses for new and existing healthcare providers, delivering findings and strategic recommendations to management.
- Ensure all negotiations are aligned with Daman’s pricing targets, securing optimal services and favorable payment terms.
- Carry out procedure code mapping for contracted services within healthcare providers.
- Analyze provider dashboards and quality reports to evaluate performance and service utilization.
- Support special projects as assigned and serve as deputy supervisor.
- Initiate cost-reduction initiatives for over utilized services such as Femtosecond and Fibro Scan, identified and rectified overpayments in physiotherapy and implemented corrective measures. Conducted comprehensive analysis of emerging healthcare technologies including rTMS, Intragastric Balloons, Basic Capacity and HBOT to enhance patient care while driving cost efficiency.
Provider Relations Officer
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2016 - 01.2019
- Recruited and onboarded healthcare providers to establish cost-effective and high-quality network.
- Negotiated contractual terms and set financial targets & performance metrics while ensuring provider engagement.
- Prepared weekly action plans and status reports for management oversight.
- Trained provider staff on claims submission, pre-authorization guidelines and insurance policies.
- Conducted an independent audit of National Screening Program claims, recovering over AED 9 million.
- Analyzed physiotherapy service utilization, identifying overpayment issues that saved AED 110 million.
- Developed a homecare strategy and billing methodology, resulting in AED 114 million savings.
Team Leader, Health Insurance Support
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2013 - 01.2015
- Deputized Health Insurance Support Supervisor and prepared KPI scorecards to evaluate team performance.
- Recommended process improvements and documented issues within HIS module (MedNeXt) to enhance accuracy.
- Consistently surpassed job metrics over five consecutive years.
- Led outreach efforts for Health Support team and established strong relationships with providers.
- Improved reporting system in healthcare to resolve recurring issues, achieving a 20% reduction in complaints.
Education
Bachelor of Science - Pharmacy – Clinical Pharmacist
Ajman University of Science And Technology
AjmanSkills
- Project management and business analysis
- Data analysis and SAS programming
- Medical and clinical coding
- Analytical skills
- Team leadership and management
- Negotiation skills
- Microsoft Office proficiency
- Report generation and presentation
- Value-based analysis
Accomplishments
- Best Performer – First 6 months, 2011
- Best Performer of the Year, 2012
- Promoted to Health Insurance Senior Position, 2012
- Promoted to Health Insurance Team Leader, 2013
- Achiever Certificate – Health Insurance Team Leader, 2014
- Promoted to Senior Provider Relations Position, 2019
- Employee of the Month – Domestic Provider Specialist, 2023
- Project Owner – Femtosecond Surgery initiative
- Weqaya Speaker at DOH , Led the redesign of the Weqaya process flow and implemented a new billing methodology.
- Basic & Thiqa Optimization – Developed and presented to DOH for enhanced operational efficiency
- Billing Mechanism Innovations – Designed new ophthalmology and orthopedic surgeries billing processes, achieving significant cost savings without compromising healthcare quality
Certification
- Project Management.
- Medical Coding.
- Data Science.
- AI For Everyone.
- SQL Basic.
- Digital Transformation.
- Foundation course on Data Science and Business Analytics.
- Basic Consulting Skills.
- Negotiation Skills.
- SAS programming - Enterprise Guide.
- Optimizing your performance.
Stakeholders
- ADNOC.
- MUBADALA.
- MEDICLINIC.
- VPS.
- NMC.
- DOH.
- FAMILY DEVELOPMENT FOUNDATION.
- GENERAL WOMEN UNION.
- EMIRATES FOUNDATION.
- MAAN.
- PUREHEALTH HOLDING.
Timeline
Project Lead, Corporate Social Responsibility
PureHealth Holdings
09.2024 - 09.2025
Assistant Manager, Domestic Contracting
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2024 - 09.2024
Specialist, Domestic Contracting
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2022 - 01.2024
Senior Provider Relations Officer
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2019 - 01.2022
Provider Relations Officer
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2016 - 01.2019
Team Leader, Health Insurance Support
NATIONAL HEALTH INSURANCE COMPANY – DAMAN
01.2013 - 01.2015
Bachelor of Science - Pharmacy – Clinical Pharmacist
Ajman University of Science And Technology
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