Ola Shehadeh
Dubai
Summary
Driven professional with strong analytical ,communication and administrative skills, able to navigate complex claims scenarios and resolve issues with precision. Proven ability to manage and interpret data Committed to enhancing claims processes and delivering optimal outcomes for patients and company.
Equipped with excellent technical expertise necessary in cultivating positive relationships with peers, staff, and management. Proficient with Microsoft Office applications (Word, Excel, Outlook, PowerPoint, and Access )
Overview
11
11
years of professional experience
Work History
Medical Claims Process Lead
Nextcare
01.2025 - Current
- Lead the end-to-end process for Durable Medical Equipment (DME) approvals under the Enaya program, (unified health insurance system serving Dubai emirate beneficiaries.)
- Collaborate with healthcare providers, DHA, and regulatory bodies to ensure timely, compliant, and evidence-based decision-making.
- Develop and implement streamlined workflows to enhance operational efficiency and reduce approval turnaround times.
- Act as the primary point of contact for escalations and cross-functional coordination related to DME and outpatient claims
- Managed teams effectively, fostering an environment of open communication and collaboration for better overall performance.
- Collaborated with other departments to address any interdepartmental challenges or discrepancies in a timely manner.
- Evaluated process performance metrics, identifying areas requiring improvement to ensure alignment with policy terms and medical necessity guidelines .
- Coordinated cross-functional teams to ensure smooth workflow and timely execution of projects.
- Evaluated vendor performance, selecting the best suppliers based on cost, and efficiency.
- Mentored junior team members, providing guidance on best practices and contributing to their professional development.
- Prepare the needed analysis and reports for continuous review of productivity and overall performance , in order to increases efficiency, and minimize errors
Senior Medical Claims Officer
Nextcare
Dubai, UAE
05.2023 - 12.2024
- 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, to ensure smooth work flow .
- Collaborate closely with company's departments to ensure compliance in all processes.
- 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, 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.
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
- Complete detailed pharmaceutical research to ensure up-to-date knowledge of new medications.
- Ensure accuracy in dispensing prescriptions, and providing information ,promoting safety of patients, for better understanding of their therapeutic regimes.
Pharmacy Director
Shaheen Pharmacy
Damascus, Syria
10.2014 - 10.2016
- Streamlined pharmacy operations by implementing efficient dispensing procedures ,and enhancing patient's safety with strict adherence to regulatory guidelines.
Education
Bachelor degree in pharmaceutical science -
Syrian Private University
SyriaSkills
- Business intelligence tools and administrative skills
- Claims investigation , report writing , and fraud awareness
- Regulatory compliance
- Negotiation techniques
- Problem solving adaptability
- Collaboration strong work ethic time management critical thinking
- Leadership skills
- Case management
Languages
English
Advanced
Arabic
Native
Trainig
- Intensive English language program -American University Dubai
- MBA course-American University Dubai Jan-2017 till Apr -2018
Marketing
Management
Corporate Finance and Accounting Information
Timeline
Medical Claims Process Lead
Nextcare
01.2025 - Current
Senior Medical Claims Officer
Nextcare
05.2023 - 12.2024
Care Centre Officer
Nextcare
03.2022 - 05.2023
Prior Approval Pharmacist
Globemed
11.2018 - 11.2021
Pharmacist Executive
Life Pharmacy
09.2017 - 04.2018
Pharmacy Director
Shaheen Pharmacy
10.2014 - 10.2016
Bachelor degree in pharmaceutical science -
Syrian Private University