SARA MAAROUF
Dubai
Summary
Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills.
Overview
7
7
years of professional experience
1
1
Certification
Work History
SEHATI Business Consultant/Analyst
Nphies - SEHATI KSA
06.2023 - 11.2023
- Audited Nphies Data warehouse and recommended system improvement.
- Worked on Enhancing Nphies Fraud Management System,
- Update Nphies resources and Business Validation rules as per business requirements/Needs,
- Nphies is KSA National Wide Platform that regulates and manage transactions between Healthcare Providers and Health Insurance Companies.
Business Analyst & Consultant
IQVIA Egypt
08.2022 - 11.2023
- Create business requirements document, software specifications document
- Assist clients in creating UAT test cases and prepare UAT test scripts
- Analyze, document and track requirements (using requirements traceability matrix)
- Conducting Sanity Check, Functional Testing, and Usability Testing
- Plan for future activities with clients and complying with project timelines and stakeholder availability
- Conduct client meetings, document business and solution requirements, and perform gap analysis
- Manage multiple projects with the help of other business analysts
- Resolve conflicting requirements and help to conclude to agreed project scope
- Contribute to Product enhancement as a functional product expert
- Evaluating business processes, anticipating requirements, uncovering areas for improvement, and developing and implementing solutions
- Manages client expectations effectively.
Automation and Claims Engine Process Lead
NEXtCARE - Dubai
05.2019 - 07.2022
- Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims
- Engaged in Regulation, Cost containment, and the company's' global projects
- Assisted in review and customization of the system according to the local market practices
- Worked with key stakeholders to define requirements and delivery milestones for new services
- Increased the percentage of the automated medical claims
- Conducted reports analysis based on the services' utilization and collaborated with Functional heads to identify opportunities for operational improvements.
Senior Care Centre Agent
Nextcare Dubai
04.2017 - 05.2019
- Evaluated medical claims and acted as intermediary between insurance companies and customers, including researching and assessing information to determine validity of claims
- Provide medical approvals, Guarantee of Payment, Guarantee of Acceptance
- Responded to calls from providers, members, brokers and payers
- Answered the customers' inquiries accurately and timely
- Collected customer feedback and made process changes to exceed customer satisfaction.
Education
Bachelor of Science - Pharmacy
Dubai Pharmacy College
Dubai, UAE06.2016
Skills
- Business Analysis
- Troubleshooting
- Requirements Gathering
- Software Testing
- User Acceptance Testing
- Healthcare System Auditing
- Agile/Waterfall Methodologies
- Project Management
- Strategic Planning
- Balsamiq Wireframe
- Stakeholder Management
- JIRA
- Software development life cycle
- Confluence
- Visio
- Microsoft Office
- BI Qlik
- Consulting
- Data Analysis
- Medical Coding and Auditing
- Pharmacy Benefit Management
- HL7 fhir Framework
- Health Insurance Claims Auto-adjudications
- Basic knowledge in PostgreSQL
- Technical understanding
- New product introductions strategies
Title
Consultant & Business Systems Analyst
Projects
Dhamani – CMA Oman, IQVIA Business System Analyst and Consultant Tech , 08/2022 – 11/2023
- Delivering and Enhancing Dhamani Provider Portal and Payerlite Products.
*Dhamani is Oman National Wide Platform that regulates and manage transactions between Healthcare Providers and Health Insurance Companies.
Nphies – SEHATI KSA, SEHATI Business Consultant/Analyst, (IQVIA Management services), 06/2023 – 11/2023
- Audited Nphies Data warehouse and recommended system improvement.
- Worked on Enhancing Nphies Fraud Management System.
- Update Nphies resources and Business Validation rules as per the business requirements / Needs.
*Nphies is KSA National Wide Platform that regulates and manage transactions between Healthcare Providers and Health Insurance Companies.
Other Projects
IQVIA Business Analyst:
- NLGI Integration with Dhamani Platform.
- Oman Insurance Health HIS Update to track resubmissions.
- Other Internal Product developments (Fraud Management System,Transaction management Bus, Map me tool, ITM Light New Products)
Nextcare Process Lead:
- Customize FDB drug indication module to meet UAE market Practice.
- Create a module to auto-adjudicate medications quantity till card expiry Or maximum period.
- Enhanced Drug duplication module and Drug Early refill to be applied on different regions.
- Contributed in Internal System Changes, and Global TPA Implementation projects (e.g., Kenya, Italy, Greece).
- Created Claim auto-processing workflow for Tunisia.
Accomplishments
- IQVIA: Impact Program Award, for enhancing team deliverable quality and Silver, Bronze Awards for contributing in developing IQVIA New product)
- Nextcare: Reduced the requirements to hire 3 FTE per year through Transaction Automotive Adjudications.
- Nextcare: Reduced the complaints by 200 calls per day through reducing the claim overrides.
- Nextcare: 10+ M AED/ YEAR FWA Reduction in claim costs through different Project initiatives.
Certification
Certified Profession Coder - AAPC
Languages
Arabic Native
English Advanced
Timeline
SEHATI Business Consultant/Analyst
Nphies - SEHATI KSA
06.2023 - 11.2023
Business Analyst & Consultant
IQVIA Egypt
08.2022 - 11.2023
Automation and Claims Engine Process Lead
NEXtCARE - Dubai
05.2019 - 07.2022
Senior Care Centre Agent
Nextcare Dubai
04.2017 - 05.2019
Bachelor of Science - Pharmacy
Dubai Pharmacy College
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