Summary
Overview
Work History
Education
Skills
Work Availability
Languages
Timeline
Generic

Usman Khalid

Khobar

Summary

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
Usman Khalid