Football
WAEL IBRAHIM
Senior Roving Doctor, IFCE
Dammam
Summary
Experienced insurance officer with over 8 years of experience in medical insurance field. Excellent reputation for resolving problems and improving customer satisfaction.
Overview
9
9
years of professional experience
6
6
years of post-secondary education
7
7
Certifications
2
2
Languages
Work History
Senior Roving Doctor
Trade Union Cooperative Company
12.2024 - Current
- Identify and report 100% of suspected fraudulent behaviors and coordinate with the fraud and reconciliation department.
- Support medical team once needed in Precertification requests handling and on spot approval once needed - maintain precertification requests processed within TAT (Turnaround Time) and SLA (Service Level Agreement)
- Monthly Savings Achieve cost containment savings of at least 200,000 - 250,000 SAR per month through effective case management and negotiation.
- Evaluate and assess a minimum of 75 - 80 inpatient cases per month within assigned regions.
- Communication Response Time Respond to 95% of inquiries from healthcare providers within 24 hours to ensure timely and accurate information gathering.
- Timeliness of Reports Prepare and submit daily roving reports and consolidate weekly and monthly reports with maximum accuracy and timeliness.
- Evaluated previously prescribed interventions for successes or failures and adjusted strategies.
Roving Doctor
Globemed Saudia
11.2018 - 11.2024
- Managing a group of hospitals to ensure that high-quality healthcare services are delivered to policyholders.
- Agree the case management plans with consultants and providers.
- Closely follow up on all in-patient cases on a daily basis.
- Raise critical issues with the provider's medical management as and when
required, and ensure all approvals and rejections are agreed upon.
- Ensure that all invoicing is in accordance with the terms of the agreement.
- Ensure that the treatment and services rendered are as per medical necessity and align with the insurance coverage, collaborate with healthcare providers to ensure
- Monitor and manage complex cases.
- Be in touch with inpatients and their relatives to promote the hospital's image and proactively solve any problems the customer or their family may have.
- Monitor any failures and bottlenecks in the customer experience and share them with leadership.
Pre-authorization Officer
Total Care Saudi
04.2017 - 10.2018
- Grant or deny the financial coverage of medical services as per the rules of
known silence of medicine, policy conditions, and CHI rules and regulations.
- Validate the identity of hospitals requesting the service to the policyholder and prevent abuse.
- Attend the call from hospitals and answer their enquiries.
- Ensure that the correspondence is not delayed more than 15 minutes. for the
complicated cases and 5 minutes. for the simple one.
- Led training sessions on regulatory compliance, enhancing team's knowledge and skills.
- Investigated complaints and took corrective actions, improving service quality
and customer satisfaction.
- Analyses incident reports, identifying trends and developing strategies to reduce future occurrences.
- Managed team of junior officers, providing leadership and guidance for
operational efficiency
General Practitioner
Central ambulance
11.2015 - 07.2016
- Providing BLS, ALS, and AED services.
- Providing urgent care for acute illnesses and injuries, stabilizing patients and arranging further treatment when necessary.
- Providing advanced life support during highway RTAs and in an ICU ambulance.
- Participating in some lifesaving procedures (intubation, NGT, and chest tube).
- Utilizing telemedicine to offer consultations and follow-ups, enhancing
accessibility for patients. - Participating in multidisciplinary team meetings, planning, and problem-solving.
- Managing and monitoring of critically ill patients on their way to a medical
center, or from one center to another. - Planning and monitoring of staff, vehicles, and equipment resourcing to maintain effective operational services delivery, as well as effective and efficient
- supervision and management of a team of operational staff.
- Attended and participate in clinical meetings and continued education training to maintain licensing.
- Focused on early detection of potential health issues through routine screenings and assessments, resulting in timely interventions when needed.
Education
Diploma - Health Data Analysis
University of Saint Josef
Lebanon 10.2023 - 07.2024
Bachelor of Science - Medicine And Surgery
National Ribat University
Khartoum-Sudan 08.2002 - 08.2007
Skills
English Language
Certification
AED provider course
Interests
Reading
Swimming
Timeline
Senior Roving Doctor
Trade Union Cooperative Company
12.2024 - Current
Diploma - Health Data Analysis
University of Saint Josef
10.2023 - 07.2024
Roving Doctor
Globemed Saudia
11.2018 - 11.2024
Pre-authorization Officer
Total Care Saudi
04.2017 - 10.2018
General Practitioner
Central ambulance
11.2015 - 07.2016
Bachelor of Science - Medicine And Surgery
National Ribat University
08.2002 - 08.2007
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