Maira Girgis
Dubai
Summary
Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient with Quality standards, performance improvement, regulatory requirements, revenue cycle management. Provide processes and Plans to reduce denials and improve revenue. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance. Proficient with Preapproval standards and operations SLAs and Payers Agreements, Terms and conditions. Excellent communication and computer skills.
Overview
22
22
years of professional experience
Work History
Manager – Quality Assurance & Complaints Management
NAS NEURON
08.2020 - 05.2024
- Managing Quality Team and ensure Members’ Complaints are investigated and handled properly within agreed TAT and as per Policy terms and Guidelines
- Customer satisfaction and Monitor Customer service team KPIs
- Assist in enhancing CS Team internal processes
- Created Processes to support seamless flow while investigating Members complaints, Facilitate CS Team communication with members, and for better member journey
- Such as (Eligibility verification process, GC03 Process)
- Monthly Quality Internal Audit on Operations Shortfalls, Root cause Analysis and discussion with Operations heads on Remedial measures and suggested action plans
- Reporting including Operations MOR, KPIs, DHA Annual reporting
- Ensure FWA Team share their quarterly reports to DHA as per agreed TAT
- Regulatory and Payers Reporting as well
- Developing strategies, processes and procedures for risk management
- Up to date on current regulatory and compliance changes
- Update Operations with DHA mandates, regulations
- Ensure the same is shared with our clients and provider Network
- Drafted Complaints SOPs (Service Operation Procedure) and developing Complaints Process workflow complying with DHA standards and mandates
- Ensure Compliance and Quality decisions are followed, up to date and documented professionally and accurately maintaining Data privacy standards
- Manage VIP Escalations and DHA Team Escalations
- Meeting with clients, payers, DHIC Team for ENAYA Unification program, assist resolving their concerns, answer inquiries and assist in understanding any process or information
- Training and coaching for all new joiners
- Identification of training requirements based on the audit findings
- Created the Complaints management-related section within Neuron and NAS websites
- Assisting with Automation projects related to Operations.
Senior Life Medical Underwriter
Aviva Insurance
08.2015 - 03.2019
- Examine insurance proposals, gather and assess all information and liaise with specialist colleagues, to effectively assess the risk
- Good understanding of insurance and the terminologies used, across all lines of business
- Good understanding of different policies and evaluation of data from various sources
- Problem solving and Good Decision making
- Good understanding of legislative and regulatory requirements
- Continuous updating of data into company systems and reporting to management to ensure that the company remains aware of any changes, updates, and financial risks
- Documentation of all data and records complying with data protection parameters and regulatory requirements
- Participate in projects or other initiatives designed to improve the effectiveness or efficiency of the department
- Maintain good relationships with all key brokers and clients
- Liaise with brokers, clients and potential clients to prepare quotes, negotiating terms as required
- Writing policies and specifying any conditions that should apply to policies
- Ensure any requests for further information are appropriate and accurate
- Ensure customer journey runs smoothly and is not impacted
- Answer all customers Inquiries
- Ensure all work is accurately recorded daily to enable accurate communications to be delivered and effective business decisions made
- Maintain Compliance and data privacy parameters.
RCM Senior Supervisor
Sheikh Khalifa General Hospital
05.2013 - 08.2014
- Manage and lead staff in the assigned department
- Mentor day to day activities, Provide assistance and Guidance
- Monitor Productivity and Efficiency of all Staff
- Manages all insurance billing, follow-up, payer enrollment, and no-response activities and maintain performance and effectiveness of the department
- Responsible of implementing short and long-term plans, efficient processes and documentation to ensure production staff assignments, duties and set up Objectives to improve Facility revenue cycle and reduce denials
- Coordinate with Payers, TPAs, insurance companies to identify reasons for delayed payment for services and additional information requests
- Identify, Compile and analyze Billing errors and denial trends related to follow-up activities
- Initiate projects based on departmental needs and leadership direction
- Coaching and empowering staff to develop methods of process improvement, including planning, setting priorities, systematic performance assessments, staff performance activities
- And maintain achieved improvements
- Regular reporting to senior management with analysis of revenue and reimbursement issues and provide action plans to improve department efficiency and overall performance and facility revenue and Money saving
- Knowledgeable of and complies with Regulations, rules, and company policies regarding compliance, integrity, patient privacy, and ethical billing and collection practices
- Promote good relationships and maintain highest level of customer satisfaction including confidentiality of patient and organization information.
RCM Insurance Supervisor
University Hospital of Sharjah
02.2011 - 02.2012
- Reporting to Chief Financial Officer, managing insurance department hospital staff
- Coaching and updating staff and coworkers with new regulations and rules
- Maintain records and documentation of regulatory mandates in a proficient confidential way
- Prepared with the team the price list of all the medical services in the hospital
- Meeting with Payers and signing of New contracts
- Manages all insurance billing, follow-up, payer enrollment, and no-response activities and maintain performance and effectiveness of the department
- Responsible of implementing short and long-term plans, efficient processes and documentation to ensure production staff assignments, duties and set up Objectives to improve Facility revenue cycle and reduce denials
- Maintain good relationships with Payers, customers, all parties internally and externally with strong effective communication skills.
Senior Medical Claims Officer
NextCare Insurance Company
02.2009 - 02.2011
- Preapproval Authorizations Outpatient, Inpatient, and Reimbursement assessing
- Medical Claims Processing
- Handling of High-cost Requests
- Knowledge of new insurance market trends and updates
- Knowledgeable of payer’s policies, terms and conditions, Table of benefits wordings
- Knowledge of Policies annual Limits, copays, deductibles, coverage areas, Knowledgeable of Medical guidelines, DHA and HAAD exclusions
- Reporting Fraud suspected cases of fraud to FWA department for investigation
- Maintain good relationships with all coworkers and build good Teamwork spirit within the team through planning of ongoing social activities
- Analyze errors and root causes, Details oriented, decision making regarding High-cost requests in compliance with Members policy terms and conditions.
General Practitioner Physician and Emergency Doctor
Police Hospital of Egypt
01.2002 - 10.2007
Education
M.D. - Bachelor of Medicine And Surgery (MBBS)
Faculty of Medicine - Ain Shams University
Cairo Egypt12.2000
Skills
- Quality Assurance and complaints management
- Customer service and customer satisfaction
- Revenue management cycle
- Negotiation skills and contract management
- Processes Improvement
- Regulatory Requirements and Mandates
- Details Oriented and Complex Problem-Solving
- Decision-Making
- Verbal and written communication
- Teamwork and collaboration
- Task delegation, Goal setting, set Objectives within the team
- Team Leadership, Team management, training and development
- Compliance standards, AML policies and Sanctions
- Time Management
- Operations management
- Key performance indicators tracking
- Root cause Analysis and Apply Remedial measures and action plans
- Automation projects and System enhancements
- Computer skills (Microsoft word, Excel, spreadsheets, Powerpoint, presentations, outlook, one drive, file management and documentation
- Reporting and Business Analysis
- Business development Plans and Processes enhancement
- Training to existing team members
- Onboarding and Orientation
- Customer Relationship Management (CRM)
- Marketing
Languages
Bilingual: English and Arabic
Certificationsandcourses
- Managerial training Course Completion, CIGNA GLOBAL, 03/2024
- LMS Courses Completion (Anti-bribery), (Anti-Corruption Training) & (Economic Sanctions Regulations), CIGNA MEA, 02/2024
- Connect to Succeed Training Coach Course by Cigna MEA, 03/2023
- ICA Certificate in Financial Crime Compliance for Insurance Sector in UAE Certificate, 03/2021
- Licensed insurance advisor accident and sickness, Alberta Insurance Council, Canada, 05/2016
Personal Information
- Nationality: Canadian
- Driving License: Valid UAE driving license
- Visa Status: Permanent Resident of UAE
Timeline
Manager – Quality Assurance & Complaints Management
NAS NEURON
08.2020 - 05.2024
Senior Life Medical Underwriter
Aviva Insurance
08.2015 - 03.2019
RCM Senior Supervisor
Sheikh Khalifa General Hospital
05.2013 - 08.2014
RCM Insurance Supervisor
University Hospital of Sharjah
02.2011 - 02.2012
Senior Medical Claims Officer
NextCare Insurance Company
02.2009 - 02.2011
General Practitioner Physician and Emergency Doctor
Police Hospital of Egypt
01.2002 - 10.2007
M.D. - Bachelor of Medicine And Surgery (MBBS)
Faculty of Medicine - Ain Shams University
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