Dynamic medical professional with a proven track record in medical cost management and emergency care, notably at Gulf Union Al Ahlia Insurance Company. Expert in strategic planning and complex problem-solving, I've led teams to achieve high-quality medical standards, ensuring patient safety and regulatory compliance. Skilled in decision-making and adaptability, I've significantly contributed to operational excellence and medical integrity.
Overview
16
16
years of professional experience
Work History
Manager - Pre Authorization
Gulf Union Al Ahlia Insurance Company
03.2019 - Current
To ensure medical (In-Patient & Out-Patient services) is controlled by ensuring that pre-authorization decisions are within defined SAMA & CCHI regulations, accepted guidelines and high quality medical standards, safeguarding the member's health & safety and aligned to company policies.
Medial Cost Management
Adjudicate the cases based on common medical practice inline with company protocols and policy.
Ensure the decisions are according to the best medical standards and agreement terms & conditions in order to prevent abuse, fraud and over treatment.
Ensure working with high quality of decision making.
Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed off by the organization.
Ensure achieving the daily targets in terms of productivity & speed of response.
Ensure proper interpretation and usage of clinical skills
Compliance to policy and Regulation
Report all high value claims as per agreed process.
Highlight and report fraud, abuse, and anti-selection.
Apply terms and conditions of Health declaration policy in SME products.
Follow CCHI policy’s terms and conditions.
Provide positive feedback and help in solving problem
Medical Doctor Roving & Pre-Authorization Officer
TCS - Total Care Saudi
04.2017 - 02.2019
Ability to answer prior approval received from medical providers within limited time specified.
Apply strong medical knowledge to detect any abuses or investigation not related to medical condition.
Make sure that treatment is medically necessary.
Make sure that planned treatment is within reasonable and customary.
Medical Doctor
POSCO - Saudi Aramco
01.2016 - 02.2017
Arriving first at the scene of a emergency and assessing a patient’s condition.
Performing triage at the scene of an emergency to determine the priority of care.
Organizing and arranging for a casualties speedy transportation to a hospital.
Assuming immediate control of accident & emergency situations.
Giving appropriate medical advice and training to healthcare colleagues.
Involved in the resuscitating and stabilization of patients.
Co-operating with other emergency services.
Completing documentation i.e. Patient Report Forms, Incident Reports.
Administering, non-prescription, prescription and controlled drugs.
Deciding on whether and how to move a injured patient.
Updating hospital staff and healthcare professionals about a patients condition.
When required administering I.V Fluids, Oxygen supplies and apply splints.
Medical Doctor
Larsen & Toubro - Saudi Aramco
09.2012 - 12.2015
Over a period of 3 years working in an Industrial Site with more than a strength of 4000 workman and
Helping in achieving 30 Million Safe Man Hours.
Arriving first at the scene of a emergency and assessing a patient’s condition.
Performing triage at the scene of an emergency to determine the priority of care.
Organizing and arranging for a casualties speedy transportation to a hospital.
Assuming immediate control of accident & emergency situations.
Giving appropriate medical advice and training to healthcare colleagues.
Involved in the resuscitating and stabilization of patients.
Co-operating with other emergency services.
Completing documentation i.e. Patient Report Forms, Incident Reports.
Administering, non-prescription, prescription and controlled drugs.
Deciding on whether and how to move a injured patient.
Updating hospital staff and healthcare professionals about a patients condition.
When required administering I.V Fluids, Oxygen supplies and apply splints.
Checking medical equipment to maintain a state of operational readiness.
Experience of Chronic Disease management i.e. diabetes and asthma, etc.
Medical Doctor
DAELIM - Saudi
02.2011 - 07.2012
Arriving first at the scene of a emergency and assessing a patient’s condition.
Performing triage at the scene of an emergency to determine the priority of care.
Organizing and arranging for a casualties speedy transportation to a hospital.
Assuming immediate control of accident & emergency situations.
Giving appropriate medical advice and training to healthcare colleagues.
Involved in the resuscitating and stabilization of patients.
Co-operating with other emergency services.
Completing documentation i.e. Patient Report Forms, Incident Reports.
Administering, non-prescription, prescription and controlled drugs.
Deciding on whether and how to move a injured patient.
Updating hospital staff and healthcare professionals about a patients condition.
When required administering I.V Fluids, Oxygen supplies and apply splints.
ER Doctor
Dammam Medical Complex
01.2009 - 01.2011
Over a period of time worked in a fast paced and busy hospital environment, dealing with medical emergencies as they occurred.
Worked in the accident and emergency ward.
Involved in ward rounds, meetings and case conferences.
Assessing newly admitted patients.
Looking after patient under my care who are on wards.
Monitoring and advising medical students and other junior doctors.
Professional Medical Development.
Previous accident and emergency (A&E) medicine experience.
Able to deal sympathetically with sensitive circumstances.
Keeping up to date with the latest treatments, medicines and medical developments.
Experience of providing care to patients on hospital wards, outpatient clinics.
Assisted in the operating theaters in surgical operations.
Education
Bachelor of Medicine Bachelor of Surgery (MBBS) - Medical
Shihezi Medical University
China
12-2009
Skills
Team Leadership
Time Management
Complex Problem-Solving
Staff Training and Development
Strategic Planning
Performance Evaluations
Key Performance Indicators
Teamwork and Collaboration
Decision-Making
Computer Skills
Effective Communication
Problem Resolution
Adaptability and Flexibility
Hiring and Training
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Languages
English
Bilingual or Proficient (C2)
Arabic
Advanced (C1)
Hindi
Bilingual or Proficient (C2)
Urdu
Bilingual or Proficient (C2)
Timeline
Manager - Pre Authorization
Gulf Union Al Ahlia Insurance Company
03.2019 - Current
Medical Doctor Roving & Pre-Authorization Officer
TCS - Total Care Saudi
04.2017 - 02.2019
Medical Doctor
POSCO - Saudi Aramco
01.2016 - 02.2017
Medical Doctor
Larsen & Toubro - Saudi Aramco
09.2012 - 12.2015
Medical Doctor
DAELIM - Saudi
02.2011 - 07.2012
ER Doctor
Dammam Medical Complex
01.2009 - 01.2011
Bachelor of Medicine Bachelor of Surgery (MBBS) - Medical
Shihezi Medical University
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