MUHAMMAD ADIL
Medical Claims Officer
Sharjah,SH
Summary
Responsible, passionate about delivering outstanding quality and service. Offering 07 years of experience in industry with history of recognition for performance. MBBS MD-certified Doctor with vast experience in effective and efficient operations. Displays outstanding knowledge and practical expertise to provide exceptional all-round service. Expert in Claims bringing 02 years of expertise in life line. Effectively manages assignments and team members. Dedicated to self-development to provide expectation-exceeding service. Driven with expertise in domestic and international claims. Possesses solid negotiation and decision-making skills. Promptly resolves queries and finalises claims within authority limits.
Overview
9
9
years of professional experience
Work History
Medical Claims Officer
Life Line (TPA)
01.2024 - Current
- Efficiently maintaining confidential information about clients' medical histories in order to ensure accurate claims processing.
- Communicating regularly with insurance agents, policyholders, and beneficiaries, to prepare claim forms; processing claim payments, answering calls & emails, checking pre-authorization requests, reconciling statements (MOH, DHA, HAAD, SEHA).
- Reviewing and verifying personal information including names, addresses, ages, assets, and other data when reviewing claim submissions.
- Adhering to company policies and local, state, and federal guidelines when facilitating insurance processing.
- Evaluating insurance policy coverage and calculating respective claim amounts to issue premiums, adjustments, refunds, and more.
- Keeping track of policy records and performing data entry to maintain accurate client information.
General Physician (Evening Shift)
Sher Ali Medical Center
04.2021 - 12.2023
- Effectively inspected and updated patients' charts.
- Diagnosed common ailments such as colds, flu, and diabetes.
- Administered medication topically, orally, and via intravenous or intramuscular injections.
- Prescribed apt medications and lifestyle alterations.
- Collected fluid and tissue samples for testing.
- Referred patients to specialists for further testing and treatment.
- Created and issued invoices to private clients.
- Submitted claims on behalf of patients who have health insurance.
- Responded to patients' concerns.
- Interviewed patients to assess histories, investigate concerns and complete physical examinations.
Lecturer in Medical Education (Morning Shift)
Swabi College of Nursing and Health Science
05.2018 - 09.2023
- Cultivated excellent student relationships by helping struggling students overcome course difficulties and educational struggles in medicine.
- Enhanced medical courses by implementing the latest curriculum requirements and best teaching practices.
- Promoted topic discussion and independent investigation to heighten student engagement.
Emergency Medical Officer, (Evening Shift)
Bu Ali Seena Medical and Surgical Complex
07.2019 - 03.2021
- Created plans and communicated deadlines to complete projects on time.
- Organised files to support efficiency and traceability.
- Achieved service time and quality targets.
- Collaborated with team members to achieve target results.
House Officer
Qazi Hussain Ahmad Medical Complex
01.2018 - 12.2018
- Completed ward rounds with consulting staff and discussed patient treatment plans.
- Performed routine medical procedures such as blood tests and administering injections.
- Shadowed qualified doctors to learn best practices and techniques regarding examinations, operations and patient consultations.
- Maintained within client confidentiality laws at all times when dealing with patient's sensitive and health information.
Internship Trainee
Lady Reading Hospital
01.2017 - 12.2017
- Sorted and distributed incoming mail and communications.
- Helped team prepare collateral for advertisements and catalogues promoting products.
- Recorded stock movement for up-to-date inventory documentation.
- Booked client appointments via online systems and maintained master calendar.
Education
Doctor of Medicine MBBS MD - Medicine and Surgery
Spinghar Medical University
Jalal Abad, Nangerhar01-2017
Skills
- Funds Recovery & Management
- Communication & Presentation Skills
- Medical Claims Management
- Insurance Claims Adjustment
- Claims Processing Software
- Diagnosis & Treatment
- Disputes Management
- Report Writing Skills
- Case Analysis
LANGUAGE
English
Advanced (C1)
Urdu
Bilingual or Proficient (C2)
Pushto
Bilingual or Proficient (C2)
Accomplishments
- Achieved Best Teacher Award of the year award for 3 years consecutively.
Timeline
Medical Claims Officer
Life Line (TPA)
01.2024 - Current
General Physician (Evening Shift)
Sher Ali Medical Center
04.2021 - 12.2023
Emergency Medical Officer, (Evening Shift)
Bu Ali Seena Medical and Surgical Complex
07.2019 - 03.2021
Lecturer in Medical Education (Morning Shift)
Swabi College of Nursing and Health Science
05.2018 - 09.2023
House Officer
Qazi Hussain Ahmad Medical Complex
01.2018 - 12.2018
Internship Trainee
Lady Reading Hospital
01.2017 - 12.2017
Doctor of Medicine MBBS MD - Medicine and Surgery
Spinghar Medical University