SAMI ELSAIED TAHA SAEED
Abu Dhabi
Summary
A Professional Doctor with more than 7 years Experience in Medical Insurance Industry. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Medical Insurance Specialist
Islamic Insurance Company
2019.02 - Current
* Pre-authorization Doctor for more than 3 years.
* Auditing, Coding, Reviewing, Monitor and Evaluation experiences.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Educated clients on insurance policies and procedures.
- Analyzed risk factors to recommend appropriate coverage levels.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Identified and resolved discrepancies between patient information and claims data.
- Reviewed provider coding information to report services and verify correctness.
- Generated reports on medical claims processing activities and results.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
Head Department of Final Approval
Prime Health for Medical Services.
2017.02 - 2019.02
- Communicated with managers of other departments to maintain transparency.
- Created and enforced department policies, procedures and standards to establish productivity and quality.
Pre- Authorization Doctor
Prime Health For Medical Services
2016.02 - 2017.02
Auditing, Coding, Reviewing, Monitor and Evaluation.
Education
Master of Public Health -
Alzaim Alazhari University
Khartoum: Sudan01.2023
Certificate of Attending The Training Course (Fundamentals of Insurance) -
ISLAMIC INSURANCE COMPANY
Khartoum: Sudan2019
Medical Internship
Khartoum: Sudan2015
MBBS -
National Ribat University
Khartoum: Sudan2013
Skills
- Health Insurance Industry Knowledge
- Financial Needs Assessment
- Medical Billing and Coding
- Final Expense Insurance
- Claim Validity Determination
- Organizational Policies
- Billing Procedures
- A willingness to accept responsibility.
- Excellent team leading, administrative, organizational, skills.
- Excellent Communication and Interpersonal skills.
- Fast learner.
- Advance User in MS Office Package (Word, Excel, Access and PowerPoint).
- Flexible, creative, team worker and can work independently.
- Enthusiasm, willingness to learn and details focus with analytical skills.
Certification
Certificate of Bachelor in Medicine and Surgery (MBBS) from Ribat National University - Faculty of Medicine 2013.
Certificate of successfully completion of (Internship) from Ministry Health Republic of Sudan.
Certificate of permanent registration in (Sudanese Medical Council) (SMC). Member of (SUDAN DOCTORS UNION).
Certificate of Good Standing issued form (Sudanese Medical Council) (SMC).
Languages
Arabic
Bilingual or Proficient (C2)
English
Bilingual or Proficient (C2)
Referrances
Head of Medical Insurance Directorate – Islamic Insurance Company.
E-mail: musab26272gmail.com
Mobile number: 00249912519065
General Manager of Prime Health for Medical Services.
E-mail: Mahmoud.yousif@primehealthsudan.com
Mobile number:00249912219595
Timeline
Medical Insurance Specialist
Islamic Insurance Company
2019.02 - Current
Head Department of Final Approval
Prime Health for Medical Services.
2017.02 - 2019.02
Pre- Authorization Doctor
Prime Health For Medical Services
2016.02 - 2017.02
Master of Public Health -
Alzaim Alazhari University
Certificate of Attending The Training Course (Fundamentals of Insurance) -
ISLAMIC INSURANCE COMPANY
Medical Internship
MBBS -
National Ribat University
Certificate of Bachelor in Medicine and Surgery (MBBS) from Ribat National University - Faculty of Medicine 2013.
Certificate of successfully completion of (Internship) from Ministry Health Republic of Sudan.
Certificate of permanent registration in (Sudanese Medical Council) (SMC). Member of (SUDAN DOCTORS UNION).
Certificate of Good Standing issued form (Sudanese Medical Council) (SMC).
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