Bahaa Samir Email & Phone Number

Cairo, Egypt

Al Jizah, Egypt

- Work closely with direct manger to find sustainable cost and time savings solutions.- Escalation of any problematic area to direct manger.- Review claims, bills, and physician notes and data to devise and refine procedures for identifying and resolving billing errors and provider billing practices.- Develop and oversee standard operating procedures to ensure consistency in business rules applied in claim adjudication.- Publish various reports.- Perform technical audit on medical claims.- Justify the rejection reasons on system in rejection cases to facilitate the reconciliation process.- Proper implementation of agreements on claims.- Coordination with other adjusters for distribution of the claims.- Formulate and handle exceptions of claims.- Individually monitors, analyzes and reports claims information including relevant health care trends and high cost claims by segment.- Perform variance analysis, assists with medical claims reconciliation and payment process development/improvement.- Aligns with fraud waste and abuse reduction initiatives.- Expand the scope of payments reviewed by using data analytics to find new opportunities.- Develop or expand performance metrics to assess the quality of our payments and their improvement over time.

Cairo, Egypt

- Managing shift night for three months.- Responsible for tracking branch sales growth ratios and identifying any issues that might affect it. - Responsible for monitoring quality standards as per ISO certification. - Well known with exceptional sales records (top achiever for six months) - Dispensing drugs for insurance patients. - Suggesting treatment option for OTC cases. - Receiving orders that has been requested via El-ezaby application .

Bachelor Of Pharmacy - Bpharm, Pharmacy

Master Of Business Administration - Mba