Ola Shehadeh
Dubai,United Arab Emirates
Summary
Driven professional with strong analytical and communication skills, able to navigate complex claims scenarios and resolve issues with precision. Proven ability to manage and interpret data alongside clear, persuasive interaction with stakeholders. Committed to enhancing claims processes and delivering optimal outcomes for clients.
Equipped with excellent communication skills and technical expertise necessary in cultivating positive relationships with customers, peers, staff, and management. Bilingual in Arabic and English. Proficient with Microsoft Office applications (Word, Excel, Outlook, PowerPoint, and Access
Overview
10
10
years of professional experience
6
6
years of post-secondary education
Work History
Senior medical claims officer
Nextcare
Dubai
05.2023 - Current
- Assess the outpatient pre-approval claims for medical eligibility based on the provided medical information, and ensure the service description codes listed in the prior authorization requests are accurately assigned according to standard medical coding rules and benefit guidelines.
- Meet strictly deadlines by proficiently managing workload, and manage administration work, to ensure smooth work flow .
- Collaborate closely with legal team to ensure compliance in all processes.
- Prepare the needed analysis and reports once needed , for continuous review of productivity, in order to increases efficiency, and minimize errors
- Maintained up-to-date knowledge of insurance regulations to uphold industry standards , and make suggestions to improve service level .
care centre officer
Nextcare
Dubai, UAE
03.2022 - 05.2023
- Provide quality actions and Problem analyzing and prober solutions toward customer's inquiry by doing the needful follow up and corrective actions.
- Evaluate outpatient claims and provide compatible authorizations with the medical necessity and policy conditions per the standard guidelines to provide the optimum required service in timely response.
- Build customer's interest and trust in the services provided by the company.
- Communicate with management to maintain an open line of communication, ensuring the implementation of the company's strategies and policies.
Prior Approval Pharmacist
Globemed
Damascus, Syria
11.2018 - 11.2021
- Responsible for chronic soaps receiving, applying the needed medical analysis, underwriting and coverage rules in order to process them on monthly basis , based on clinical and confident decisions on medical cases based on guidelines and professional judgment.
- Review medicines prescription to assure accuracy, compatibility with therapeutic regimen to evaluate their suitability and eligibility according to insurance policies and conditions.
Pharmacist Executive
Life Pharmacy
Dubai, UAE
09.2017 - 04.2018
- Have an extensive and deeply knowledge in pharmaceutical market in UAE
- Enhance patient care by providing accurate medication information and advice.
- Provide comprehensive review with the patients for better understanding of their medication regimes.
- Complete detailed pharmaceutical research to ensure up-to-date knowledge of new medications.
- Ensure accuracy in dispensing prescriptions, ensuring safety for patients.
- Liquidating expiry ,carry out inventory and merchandising
- Develop positive business relationships with customers and suppliers at pharmacy level to achieve continuous revenue increasing and maintain high levels of customer satisfaction at all time .
Pharmacy Director
Shaheen Pharmacy
Damascus, Syria
10.2014 - 10.2016
- Streamlined pharmacy operations by implementing efficient dispensing procedures.
- Led team of pharmacists for improved patient outcomes.
- Enhanced patient safety with strict adherence to regulatory guidelines.
Education
Master of Business Administration (Incomplete ) -
American University Dubai
Dubai 01.2017 - 04.2018
Bachelor degree in pharmaceutical science - Pharmacy
Syrian Private University
Syria 09.2009 - 06.2014
Skills
- Business intelligence tools
- Claims investigation
- Claim report writing
- Regulatory compliance
- Negotiation techniques
- Fraud awareness
- Policy analysis
Problem Solving Adaptability
Collaboration Strong Work Ethic Time Management Critical Thinking
Handling Pressure
Leadership
Languages
English
Advanced
Arabic
Native
Timeline
Senior medical claims officer
Nextcare
05.2023 - Current
care centre officer
Nextcare
03.2022 - 05.2023
Prior Approval Pharmacist
Globemed
11.2018 - 11.2021
Pharmacist Executive
Life Pharmacy
09.2017 - 04.2018
Master of Business Administration (Incomplete ) -
American University Dubai
01.2017 - 04.2018
Pharmacy Director
Shaheen Pharmacy
10.2014 - 10.2016
Bachelor degree in pharmaceutical science - Pharmacy
Syrian Private University
09.2009 - 06.2014
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