Asif Ahammed
Muscat,Oman
Summary
Assistant manager with a focus on provider management, adept in claims adjudication, pre-approvals, and fraud detection. Proficient in fostering provider relations, optimizing network operations, and negotiating contracts to achieve operational excellence. Experienced in leveraging digital platforms to enhance efficiency and streamline workflows. Dedicated to delivering measurable business results through strategic process improvements and client-focused initiatives.
Overview
4
4
Languages
16
16
years of professional experience
Work History
Assistant Manager – Provider Management
Oman Qatar Insurance Company
Muscat
06.2023 - Current
- Negotiate provider contracts and pricing, aligning with market benchmarks.
- Managed provider relations and claims operations, ensuring compliance and implementing fraud prevention measures.
- Maintained TAT for billing, reimbursements, and provider payments to uphold service standards.
- Introduced new services for network providers, strengthening engagement and profitability.
- Integrated Dhamni platform with providers and pharmacies, streamlining approvals, digital connectivity, and enhancing operational efficiency.
- Supported digital transformation initiatives by aligning Dhamni workflows with OQIC policies and provider agreements.
- Mentored cross-functional teams and delivered competitor analysis reports to inform strategic decision-making.
Senior Medical Insurance Officer
QLM Life & Medical Insurance QIC
Qatar
03.2018 - 06.2023
- Managed provider networks and optimised claims operations to improve service delivery.
- Supported pre-approval and claims teams, ensuring compliance and timely settlements.
- Negotiated provider pricelists and introduced new services to enhance value for members.
- Conducted competitor analysis and provided strategic recommendations to strengthen provider relationships.
Senior Executive – Medical Claims
Bajaj Allianz Health Insurance
India
12.2016 - 01.2018
- Processed reimbursement claims by assessing admissibility through medical expertise, ensuring compliance with industry standards.
- Conducted ICD coding and internal audits to verify accuracy, contributing to overall claims integrity.
- Monitored turnaround time for processing claims to ensure efficiency. and improved rejection ratios to meet industry standards.
- Handled medical queries from brokers and members, enhancing customer satisfaction through effective communication and support.
Medical Advisor – Pre-Approvals
Sharak Healthcare (TPA for NLGIC Oman)
India
09.2015 - 11.2016
- Managed OP/IP pre-approvals, streamlining cashless treatment processes.
- Maintained healthy claim ratio by facilitating efficient approval processes.
- Ensured strict TAT compliance, enhancing operational reliability through internal audits.
Homeopathic Doctor
HMS Homeopathic Medical Hospital
India
05.2010 - 07.2015
- Conducted holistic diagnosis and treatment, enhancing patient well-being and satisfaction.
- Delivered comprehensive patient care, fostering trust and collaboration in doctor-patient relationships.
- Worked with healthcare professionals in referring and solving complex and emergency care cases.
- Communicated benefits of healthy lifestyles to clients, prescribed exercises and conducted exercise sessions for healthy patient living.
- Reviewed and recorded patients' progress through treatment plans, noting adverse reactions and adjusting treatment methods.
Education
Bachelor of Homeopathic Medicine and Surgery -
Vinayaka Mission’s Homeopathic Medical College
Salem, India01-2009
Skills
- Claims assessment
- Pre-approvals
- Cashless processing
- Network management
- Contract negotiation
- Process improvement
- Stakeholder engagement
- Issue resolution
- Client relations
- Team leadership
- CRM management
- Data interpretation
Custom
Claims adjudication, Pre-approvals, Cashless claims, Fraud detection, Network optimization, Contract negotiation, Benchmarking, Relationship building, Team development, P&L assessment, Business impact analysis, Process improvement, Complaint resolution, Client engagement, CRM systems, MS Office, Data Analysis, ICD coding, English (Fluent), Tamil (Native), Hindi (Fluent), Malayalam (Fluent), Arabic (Intermediate)
Languages
English
Advanced
C1
Hindi
Advanced
C1
Malayalam
Advanced
C1
Tamil
Advanced
C1
Timeline
Assistant Manager – Provider Management
Oman Qatar Insurance Company
06.2023 - Current
Senior Medical Insurance Officer
QLM Life & Medical Insurance QIC
03.2018 - 06.2023
Senior Executive – Medical Claims
Bajaj Allianz Health Insurance
12.2016 - 01.2018
Medical Advisor – Pre-Approvals
Sharak Healthcare (TPA for NLGIC Oman)
09.2015 - 11.2016
Homeopathic Doctor
HMS Homeopathic Medical Hospital
05.2010 - 07.2015
Bachelor of Homeopathic Medicine and Surgery -
Vinayaka Mission’s Homeopathic Medical College