Syed Ahmedullah Hussaini

Experience

• 

  Hyderabad

  May 2011 - Jul 2012

  Nulife pharmaceutical

  As medical represantatve,

• 

  GIG Saudi

  Nov 2012 - now

  Process claims (Reimbursement and Direct Billing) following procedure and in accordance with the conditions & terms of the policies.• To respond to and liaise as required with medical insurance policy holders, insurance brokers and network providers in a professional and courteous manner.• Handle relationships with clients and brokers regarding reimbursement claims by asking for additional information whenever required, by explaining the details of the settlements (application of the deductible and coverage, justify rejections and uncovered expenses.)• Handling the approvals / assessment and reconciliation of outpatient & inpatient claims. Capable of interacting with doctors and training non-medical staff on insurance terms and protocols.• Identify areas for Process Improvement or Cost Efficiency and ensure multifunction coordination to ensure implementation of Guidelines or System Enhancements.• Conduct training sessions including to Medical insurance claim team members on specified subjects as a Subject Matter Expert and also Branch Operations and other concerned groups on Medical insurance matters.• Handling relations with the medical providers which includes discussing treatment with the patient’s attending Doctor, verifying cost for such treatment in relation to agreed rates, and visit the Medical Providers on a regular basis.• Analyze prior-approval requests, negotiate the cases with the medial providers, approve the cases when agreement is reached and enter the claim into Insurance E.C. IT system;• Assist Medical Claims Administrators in assessment of claims; Process the claims within a reasonable time frame within SLA عرض أقل

  • Medical reconciliation specialist

    Sept 2023 - now

  • Medical Claims executive

    Nov 2012 - Sept 2023