Roqayah Albasri
Risk Management And Internal Audit
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
9
9
years of professional experience
7
7
years of post-secondary education
2
2
Languages
Work History
Assistant of risk, audit manger
01.2020 - Current
- Objectively review an organization'sbusiness processes by working on internalauditing for many department by extractingdata from oracle and work on excelformulas to make the KPI report
- Total care company (TPA)
- Manage the interaction between Hospitals and
- Insurance Companies for paymentinquires and resolve any payment disputes
- Support other functions in translating medicalreports to English
Administrator supervisor
Total Care Company
Alkhobar
2017 - 2019
- Collaborated with team members to achieve target results.
- Learned new skills and applied to daily tasks to improve efficiency and productivity.
- Conducted research, gathered information from multiple sources and presented results.
- Identified issues, analyzed information and provided solutions to problems.
- Prepared variety of different written communications, reports and documents.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Exceeded goals through effective task prioritization and great work ethic.
- Increased customer satisfaction by resolving issues.
- Resolved conflicts and negotiated mutually beneficial agreements between parties.
- Offered friendly and efficient service to customers, handled challenging situations with ease.
- Worked with customers to understand needs and provide excellent service.
Medical Claims Processor
total care company
khobar, saudi arabia
06.2013 - 06.2017
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Managed large volume of medical claims on daily basis.
- Reviewed provider coding information to report services and verify correctness.
- Paid or denied medical claims based upon established claims processing criteria.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Maintained confidentiality of patient finances, records and health statuses.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Checked documentation for accuracy and validity on updated systems.
Education
Bachelor of Business Administration -
Imam Abdulrahman Bin Faisal University
Alkhobar 08.2015 - 05.2019
Health Insurance Diploma - Health Insurance
Al-Mana Health Institute
Alkhobar 09.2010 - 06.2013
Skills
Internal audit procedures
Coordination of Administrative Activities
Risk Reporting
Health insurance industry knowledge
Insurance industry experience
Completing insurance forms
Healthcare regulations
Report Development
Writing reports
Office management
Human resource laws
Database administration
Presentation design
Workflow planning
Administrative support
Additional Information
❖ project management and other tools for career development -
University of california,irvine
❖ Certified compliance officer GGC prep course - IBS training academy
❖ Certified compliance professional - the financial academy
❖ Certified internal auditor - financial training center
❖ Anti-money laundering and terrorist financing course -
Technical and vocational training corporation
❖ IFCE - Saudi Arabian Monetary Agency
Quote
The way to get started is to quit talking and begin doing.
Walt Disney
Timeline
Assistant of risk, audit manger
01.2020 - Current
Administrator supervisor
Total Care Company
2017 - 2019
Bachelor of Business Administration -
Imam Abdulrahman Bin Faisal University
08.2015 - 05.2019
Medical Claims Processor
total care company
06.2013 - 06.2017
Health Insurance Diploma - Health Insurance
Al-Mana Health Institute
09.2010 - 06.2013