Mohamed Elheddeny
Al-Khobar city
Summary
Physician and health insurance professional with extensive experience in medical approvals, utilization management, and clinical audit within the Saudi insurance market. Currently serving as Medical Approval Senior Officer at Walaa Cooperative Insurance, leading medical audit initiatives and designing the department’s internship training program. Skilled in medical necessity review, CHI regulations, and cost-containment strategies, with a proven ability to optimize healthcare utilization while ensuring regulatory compliance and high-quality patient care.
Overview
10
10
years of professional experience
2014
2014
years of post-secondary education
Work history
Neonatology visitor resident
Neonatology Department of Obstetrics & Gynecology hospital, Ain shams university hospitals
Cairo
2018.01
General Practitioner
Egyptian Ministry of Health
Cairo
2016.01
- Manager of a Primary Health Care Unit in Cairo Governorate.
House Officer
Ain Shams University Hospital
2015.01
Medical Approval Senior Officer
Walaa Cooperative Insurance Company
2025.01 - 2026.03
- Medical Audit: Task Owner Lead medical audit activities to detect overutilization, inappropriate approvals, and anti-selection cases, contributing to cost containment initiatives.
- Internship Program: Task Owner Designed and implemented the medical department internship program, including structured training materials and case-based learning for new joiners.
- Perform clinical review and preauthorization for medical services in line with CHI guidelines, medical necessity criteria, and policy benefits.
- Participate in UAT and clinical rule validation for the Cover-Go system to ensure accurate medical approval workflows.
- Support development of internal clinical protocols and training to improve consistency in medical decision-making.
- Issuing daily approvals and claims medical auditing.
- Managing the posting, evaluation and distribution of the monthly medications for all beneficiary.
Approval Manager
Mouwasat Hospital
Jubail
2021.11 - 2026.03
- Manage the medical approval team in accordance with the organization’s vision and quality.
- Ensure that the team performance and the process workflow is compliant with CHI standards.
- Nphies Platform & other market regulations.
- Monitoring & analyze rejection rate.
- Coach, and guide the Medical Approval team and Performance Evaluation.
- Aramco liaison (April 2022 – present)
- CHI Ambassador (Jan. 2023 - present)
Pre-authorization Team leader
Limitless TPA
2021.05 - 2021.10
- Case Management to promote a more cost-effective and optimized medical care for Inpatient cases within the medical guidelines and policy terms.
Senior Medical Reviewer
Med-Net Egypt
2019.06 - 2021.05
- Handling complains and insuring customer satisfaction.
- Case Management to promote a more cost-effective and optimized medical care for Inpatient cases within the medical guidelines and policy terms.
- Orienting and training new members.
- Issuing daily approvals and communicating with the client with our decision.
- (TPA Company)
Pediatrics & neonatology resident
Heliopolis hospital
2018.01 - 2021.01
Senior Medical Officer
Globe-Med Egypt
2018.09 - 2019.06
- Handling complains and insuring customer satisfaction.
- Working on developing new criteria to ease the long-complicated process for the client.
- Issuing daily approvals and claims medical auditing.
- (TPA Company)
Medical Officer
Prime health - Medgulf Egypt
2015.11 - 2018.08
- Issuing daily approvals and claims medical auditing.
- Orienting and training new members.
- (TPA Company)
Education
Bachelor of medicine & surgery - Faculty of Medicine
Ain Shams University
Cairo, EgyptSkills
- Microsoft office (Word, PowerPoint, Excel & Outlook), Power BI
- Presentation Software: Power Point
- Spreadsheets: Excel Sheets, Google Spreadsheets
- Advanced data analysis
- Disciplinary action execution
- Delegation mastery
- Leadership excellence
- Creative visioning
- Operational supervision
- Performance evaluation
LANGUAGES
English: (Fluent)
Arabic: Fluent (Mother tongue)
PERSONAL INFO.
- Date of Birth: 30 March 1991
- Marital status: Married
- Nationality: Egyptian
Timeline
Medical Approval Senior Officer
Walaa Cooperative Insurance Company
2025.01 - 2026.03
Approval Manager
Mouwasat Hospital
2021.11 - 2026.03
Pre-authorization Team leader
Limitless TPA
2021.05 - 2021.10
Senior Medical Reviewer
Med-Net Egypt
2019.06 - 2021.05
Senior Medical Officer
Globe-Med Egypt
2018.09 - 2019.06
Neonatology visitor resident
Neonatology Department of Obstetrics & Gynecology hospital, Ain shams university hospitals
2018.01
Pediatrics & neonatology resident
Heliopolis hospital
2018.01 - 2021.01
General Practitioner
Egyptian Ministry of Health
2016.01
Medical Officer
Prime health - Medgulf Egypt
2015.11 - 2018.08
House Officer
Ain Shams University Hospital
2015.01
Bachelor of medicine & surgery - Faculty of Medicine
Ain Shams University