Zafer S.

Experience

• 

  Ghadeer pharmacy

  Jun 2002 - Apr 2009

  Pharmacist

  *dispensing prescription medicines to the public*ensuring that different treatments are compatible*checking dosage and ensuring that medicines are correctly and safely supplied and labelled.*supervising the preparation of any medicines.*keeping a register of controlled drugs for legal and stock control purposes*liaising with doctors about prescriptions*selling over-the-counter medicines*counselling and advising the public on the treatment of minor ailments*advising patients of any adverse side-effects of medicines or potential interactions with other medicines/treatments*undertaking Medicine Use Reviews (MUR), an advanced service to help patients understand how their medicines work andwhy they have to take them*providing a prescription intervention service*dispensing emergency hormonal contraception*measuring and fitting compression hosiery*monitoring blood pressure and cholesterol levels*offering a diabetes screening service*providing pregnancy testing*arranging the delivery of prescription medicines to patients*overseeing the ordering and safe storage of medical products*maintaining computerised records*managing, supervising and training pharmacy support staff*selling healthcare and other products, such as toiletries, cosmetics and photographic items*budgeting and financial management*promoting sales and developing the business*keeping up to date with current pharmacy practice, new drugs and their uses. Show less

• 

  WAPMED TPA Services Co.

  Oct 2010 - Jan 2013

  Medical claims and authorisation officer

  Handled customer service calls for both medical and dental claims status and coverage questions.Adjudicated for incoming provider claims outpatient, chronic, maternity, dental and physiotherapy.Proper evaluation of the target claims within the regulation insurance companies policies.Report all the abuse and fraud cases to medical insurance manager.Reporting all high risk non-declared cases discoveries.Cooperating with colleagues of the department approaching the right decision.Proper communication with internal, external customers, provider delegates, roving doctors to finalize on any adjudicatedclaims under investigation for business sake.Sharing the unique experiences with colleagues for business enhancement and unifying the processing mechanism of thedepartment.Cooperating with colleagues of the department approaching the right decision. Show less

• 

  First Takaful

  Jun 2013 - now

  1.General Management of Insurance Claims 2. Auditing approved claims from the TPA and issue reports highlighting the area of concerns and following it up with them with the proposed changes/improvements and to monitor the impact of these changes toward overall claim cost reduction3. All pre-approval requests from TPA/Providers as per the protocol of service and to take a decision.4. Provide training to medical claim team.5. Provide medical advices for TPA/Clients insured with the Company6. Resolve issues and complaints from both hospitals and clients to facilitate the services.7. Explain Policy terms and the actual application of exclusions to both the providers and clients.8. Leads the development, approval, authorization of agreed protocol of services, procedures and policies in terms of the service standardization9. Build relationships with the key persons in hospitals to facilitate the way of direct connection. Show less Responsible for receiving claims from clients, review and handle all Life & Medical insurance claims, update claims on thesystem and follow up with TPA & Medical providers in a timely and effective manner.•Implement Life & Medical claims policies and procedures in order to achieve department objectives.•Receive Life & Medical claims and ensure that all required information for processing is available.•Forward claims to TPA & medical providers to finalize the processing of re-imbursement claims.•Prepare the amount of liability towards the parties involved.•Process approved Life & Medical Claims and coordinate with Finance department for reimbursement of parties involved.•Coordinate forall claims investigation by the TPA and the Claims Officer, determine whether coverage should be provided,and oversee the approval or rejection of claims based on TPA & Medical providers.•Assist in preparing a weekly suspended & denied claims report and a paid & outstanding claims report.•Ensure good relations with related service providers and clients, handle problems between them and negotiate terms andconditions with the provider.•Maintain claim files along with an effective diary system to ensure that all claims are handled in a timely manner, anddocument claim file activities in accordance with established procedures.•Ensure and update clients’ claims are available & updated on the system..Assist the manager in organizing, planning and implementing strategy.Coordinate operations and ensure schedules and objectives are met.Supervise and motivate staff..Create reports, analyze and interpret data..Secure adherence to company’s policies and guidelines. Show less Responsible for receiving claims from clients, review and handle all Life & Medical insurance claims, update claims on thesystem and follow up with TPA & Medical providers in a timely and effective manner.•Implement Life & Medical claims policies and procedures in order to achieve department objectives.•Receive Life & Medical claims and ensure that all required information for processing is available.•Forward claims to TPA & medical providers to finalize the processing of re-imbursement claims.•Prepare the amount of liability towards the parties involved.•Process approved Life & Medical Claims and coordinate with Finance department for reimbursement of parties involved.•Coordinate forall claims investigation by the TPA and the Claims Officer, determine whether coverage should be provided,and oversee the approval or rejection of claims based on TPA & Medical providers.•Assist in preparing a weekly suspended & denied claims report and a paid & outstanding claims report.•Ensure good relations with related service providers and clients, handle problems between them and negotiate terms andconditions with the provider.•Maintain claim files along with an effective diary system to ensure that all claims are handled in a timely manner, anddocument claim file activities in accordance with established procedures.•Ensure and update clients’ claims are available & updated on the system. Show less

  • Senior Manager Life & Medical claims /underwriting

    Apr 2022 - now

  • Manager - Life & Medical Claims

    May 2017 - Apr 2022

  • Assistant Manager

    Mar 2016 - Apr 2017

  • Medical Insurance officer

    Jun 2013 - Feb 2016