Zain Adam
Jeddah
Summary
Experienced with insurance policy analysis, risk assessment, and client management. Utilizes analytical skills to evaluate and mitigate risks, ensuring policy compliance and client satisfaction. Track record of effective communication and problem-solving in diverse situations.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Provider Network Administration Supervisor
Saudi Enaya Cooperative Insurance Company
05.2015 - Current
- Served as the primary liaison with the TPA to address and resolve operational, technical, and claims-related issues efficiently.
- Achieve competitive prices and agreements with providers to help us with better medical cost management and improve effectiveness of medical spending.
- Manage the delivery of training session & development programs to provider’s staff for new systems, polices & procedures.
- Handle all the issues related to Nphies system.
- Plan, arrange, scheduling for reconciliation meetings prepared with accurate information.
- Review, Study and investigate the rejection details such as medical rejection, technical rejections and Different prices for polyclinics and Hospitals.
- Negotiate with the providers to achieve the best rejection rate based on the findings and initial rejections.
- Follow up with providers during the contract life cycle.
- Sustain a strong professional relationship with providers to improve provider and member satisfaction.
- Oversaw complaints management processes and ensured effective, timely resolution in alignment with organizational standards.
- Prepared and submitted regulatory reports pertaining to provider network operations and claims settlement matters in compliance with applicable guidelines.
- Supported the development, optimization, and structural enhancement of provider networks to improve service accessibility and performance.
- Contributed to core system technical enhancement initiatives by providing operational requirements, validations, and subject-matter input.
Provider Network Administrator
Saudi Enaya Cooperative Insurance Company
07.2012 - 04.2015
- Price list sorting of each new provider by accomplishing the appropriate grouping and mapping to each price list.
- Compare the providers’ price lists by creating the appropriate common services of each price list.
- Identifying price lists errors in MedNext system
- Manage the communication with system’s operator in the price list uploading process.
- Communicate and coordinate with other departments to ensure finalizing the uploading process.
- Performing quality check to all uploaded price lists & assures the 100% accuracy of the uploaded data.
- Assist in the payment process of the financial statements & settlements.
- Assure responding to all the provider inquiries & requests.
- Provide complete training to new joiners on the performed tasks.
- Assist all the team members to finalize outstanding issues/duties if needed.
- Train new healthcare providers on Saudi Enaya approval system, and Saudi Enaya billing system
- Assist in the payment process of the signed off statements & settlements.
Provider Relations Coordinator
Globe Med Saudi
11.2006 - 03.2011
- Planning and scheduling meetings or appointments.
- Preparing reconciliation data.
- Executive secretary for the regional manager.
- Network officer & hospital coordinator (dealing with providers regarding the price list –claims –online system).
- Establish good relationships with new providers, assess the integration to network.
Patient Affairs Representative
Bugshan Hospital
10.2002 - 10.2006
- Processing of the insurance companies’ approval requests.
- Keep track of any pending approval requests.
- Activation of insurance policies in the hospital’s system. Coordinate communication between patients, medical staff, and insurance companies.
- Schedules patients’ appointments into computerized scheduler with a high rate of accuracy.
- Registers patients by verifying that patient’s record is up to date and accurate.
- Enters confidential personal health information and financial information into computerized system with a high rate of accuracy.
- Collects payment from patients, applies payments and adjustments to patient accounts in the computer system, and reconciles daily cash reports.
- Reviews medical records for completeness, assembles records into standard order, and files records in designated areas according to applicable alphabetic and numeric filing systems.
- Organizes and maintains a filing system for patient charts.
Education
Certificate -
Chartered Insurance Institute
Certificate in Insurance Foundation (IFCE) - undefined
Saudi Arabian Monetary Agency
Diploma - Medical Conding & Reimbursement
Meeta Health Care
03-2026
Skills
- Analytical & Problem-Solving Skills
- Overseeing and planning skills
- Ability to manage stressful situations
- Complaints Management & Resolution
- Stakeholder & Provider Relations
- Technical System Enhancement Support
- Data Review and Quality Assurance
- Communication & Cross-Functional Collaboration
Certification
- Advance Negotiation.
- MS Excel, Word, PowerPoint, Access.
- Medical Terminology Training
- Time Management
- Insurance underwriting Process
- Communication Skills
- Anti Money Laundry
- Quality Assurance Awareness
INSUARNCE SPECILIST
- Over 15 Years’ Experience in Medical Insurance Field
- (Claims Management, Provider Relations, Provider Contracting, Reconciliation, Rejection Negotiation, Unit Cost and Prices Analysis, Anti-Fraud & Abuse Detection).
Languages
Arabic
Native or Bilingual
English
Full Professional
Timeline
Provider Network Administration Supervisor
Saudi Enaya Cooperative Insurance Company
05.2015 - Current
Provider Network Administrator
Saudi Enaya Cooperative Insurance Company
07.2012 - 04.2015
Provider Relations Coordinator
Globe Med Saudi
11.2006 - 03.2011
Patient Affairs Representative
Bugshan Hospital
10.2002 - 10.2006
Certificate in Insurance Foundation (IFCE) - undefined
Saudi Arabian Monetary Agency
Certificate -
Chartered Insurance Institute
Diploma - Medical Conding & Reimbursement
Meeta Health Care