Mohamed Awadalla
ETOBICOKE,ON
Summary
Approachable Claims Processor proudly offering over eight years of experience in handling multiple administrative responsibilities in fast-paced office environments. Hardworking professional interacting with providers to discuss claim status or denials. Attentive to details and highly collaborative.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Medical Board Manager
AXA/ GIG Insurance company
Riyadh, Saudi Arabia
11.2019 - 05.2023
- Manage Medical Board department.
- Supervises concurrent review and adjudicates all medical-related cases (chronic diseases, Acute, Short-Term Disability, Long Term Disability, Life, and Critical Illness, Transport insurance "Uber", Travel insurance).
- Interact directly with clients and patients professionally, ensuring all their needs are met for ultimate satisfaction Communication with Account executives/Brokers on medical queries/Advice.
- Manage projects to enhance the system with the IT team (Desktop company Apps. and Mobile App.).
- Close monitoring of the workflow by regular reports analysis.
- Detect and investigate fraud cases.
- Distribute team duties and responsibilities.
Medical Board Consultant
AXA insurance company
Riyadh , Saudi Arabia
12.2014 - 05.2019
• Manage PRE-Authorizations /claims requests.
• Monitor high-value requests.
• Handling Key Accounts broker's complaints
• Handle clients' complaints.
• handle medical board timetable.
• Replace the medical board manager during his vacations.
• Process the pre-Authorizations claims. (Inpatient, Outpatient, Dental, Pharmacy).
Internship Doctor
Ministry of health
Khartoum, Sudan
01.2013 - 01.2014
completed the internship as follows:
1. Medicine From 01/01/2013 To 02/04/2013
2. General Surgery From 04/04/2013 To 04/07/2103
3. Pediatric From 5/7/2013 To 05/10/2013
4. Obstetric and Gynecology From 06/10/2013 To 05/01/2014
Education
Bachelor of Medicine, Bachelor of Surgery (MBBS)
The National Ribat University
Khartoum, Sudan02-2012
Skills
- Benefit specialist
- Customer Service
- Data Analysis skills
- Proficient in Microsoft Office Suite
- Business Development
- Cost containment
- Excellent knowledge of stakeholder relations
- Medical coding standards
- Proactive
- Confidentiality, Data Entry, and Typing
- Project Management
- Time Management
Certification
• Certificate of Advanced Medicine course. 2010
• Certificate of the internship. 2014
• Certificate of full registration in Sudan Medical Council. 2014
• Certificate of full registration in Saudi Commission for Health Specialties 2016
• Certificate of Insurance Foundation Professional Exam Certificate (IFCE). 2016
• Certificate of 6 Critical practices for leading a team FranklinCovey Middle East 2021
• Certificate of Revenue Cycle Management Healthcare 2022
• Certified ISO 45001 : 2018 | Occupational Health & Safety Management System Auditor Training 2022
Projects
• High-cost medications project.
• Smart Auto-process project.
• Pharmacy referral project.
• Medication delivery project.
• NPHIES project.
• Home care project.
• Telemedicine project.
Languages
English
Full Professional
Arabic
Native/ Bilingual
Achievements
- Decrease client complaints by 70%
- Commit to SLA by 100%
- Improve the average TRT by 6 minutes.
- Increased percentage of fraud detected cases by 120%.
- Automate the work flow by 100%.
- Increase claims saving percentage by 13%.
- Highest Customer Satisfaction Score.
- Maintain the los ratio below 80% for 98% of insured companies.
Timeline
Medical Board Manager
AXA/ GIG Insurance company
11.2019 - 05.2023
Medical Board Consultant
AXA insurance company
12.2014 - 05.2019
Internship Doctor
Ministry of health
01.2013 - 01.2014
Bachelor of Medicine, Bachelor of Surgery (MBBS)
The National Ribat University
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