Khalid Mohammed
Riyadh
Summary
Well organized and experienced Medical Claims Specialist / Claims Processor with a proven track record of success in providing clients with outstanding customer service and support. Deep understanding of insurance policies, procedures, Negotiation and is highly skilled in managing large-scale insurance programs. Reliable and detail-oriented professional with excellent problem-solving skills.
Overview
13
13
years of professional experience
Work History
EXECUTIVE INSURANCE ORGANIZER
ALZARGAA SPECIALIZED OPTHALMOLOGY HOSPITAL
Khartoum, Sudan
06.2016 - 04.2023
- Maintained smooth operations through careful management of office workflow and administrative processes.
- Managed team performance, celebrating successes and identifying areas to improve.
- Maintained organizational compliance with applicable legislation and regulations.
- Monitored operations to assess and highlight results.
- Negotiating with leads and using persuasion techniques to overcome objections and landing deals that are beneficial to the company, while also providing customers with optimal value
- Demonstrated ability to improve sales and marketing operations, increase top line sales, and reduce costs
- Maintain the highest standards of professional conduct at all times when dealing with clients.
Medical Network Organizer
SWISS MEDITERRANEAN HEALTH MANAGEMNT
Khartoum, Sudan
07.2012 - 05.2016
- Remained calm under pressure to resolve issues and deliver smooth, professional event management.
- Managed large-scale events from initial planning to successful completion.
- Welcomed guests into venues, showing them to tables and providing menus.
- Explained event packages, options and prices clearly to customers.
- Adhering to adjudication policies for accurate claims payment.
- Accessing and processing claims in the ERP system after investigation
- Analyzing client history and reviewing premium payments. Providing prompt service to customers, providers, and billing departments regarding claims
- Addressing claim settlement issues and conducting claim audits for quality assurance
Insurance Claim Agent
IMPERIAL HOSPITAL
Khartoum, Sudan
04.2010 - 11.2012
- Managed customer relationships to achieve high satisfaction rate.
- Answered calls and resolved queries within target timeframes to achieve KPIs.
- Used interpersonal skills to deliver excellent internal and external customer service.
- Fulfilled client requests within agreed timeframes to maintain satisfaction.
- Monitoring ethical and professional standards in claim processes
- Collaborating with claims department for claim evaluation
- Managing provider negotiations and service pricing in the system
- Overseeing payment settlements and approvals
- Supervising and assisting insurance claims department
Education
Diploma - Translation
SUDAN NEWS AGENCY
01.2009
Diploma - Computer Sciences
NEEL OMDURMAN TRINING CENTER
01.2008
Bachelor of Arts - English language
OMDURMAN ALALHIA UNIVERSITY
01.2007
Skills
- Strong Communication and Interpersonal Skills for Effective Relationships with Customers
- Proficient in MS Office Suite, Database Applications, And ERP Systems
- Strategic planning
- Skilled in Accurate Data Entry and Maintaining Data
- Confidentiality
- Strong Time Management Skills for Prioritizing Tasks and Meeting Deadlines
- Analytical and Critical Thinking Skills to Identify and Correct Billing Errors
LANGUAGES
English - Fluent
Arabic - Native
References
Musab, Mohammed Ali, Administrative Manager, +966 537 504302, Al Zarga Specialized Eye Center, Khartoum, Sudan
Timeline
EXECUTIVE INSURANCE ORGANIZER
ALZARGAA SPECIALIZED OPTHALMOLOGY HOSPITAL
06.2016 - 04.2023
Medical Network Organizer
SWISS MEDITERRANEAN HEALTH MANAGEMNT
07.2012 - 05.2016
Insurance Claim Agent
IMPERIAL HOSPITAL
04.2010 - 11.2012
Diploma - Computer Sciences
NEEL OMDURMAN TRINING CENTER
Bachelor of Arts - English language
OMDURMAN ALALHIA UNIVERSITY
Diploma - Translation
SUDAN NEWS AGENCY