Sayed Naser Ali

As FWA Team Leader and part of Allianz CRU team, and primarily holding the role of Fraud analyst, I have been responsible of communicating with BI (business intelligence) team, requesting the necessary data, analyze it for anomalies and patterns in billing, benchmarking providers from different aspects, including average cost per claim, number of members visiting the provider, average number of visits per member, utilization of items compared to past years and growth of business, comparing prices of the items compared to the market, comparing the discount percentage and how much it yields, look for incorrect billing patterns, such as billing Dental Consultation along with dental procedures, billing package items unbundled, comparing practices to local regulator guidelines and international guidelines, comparing the utilization of physicians of the same facility and benchmarking it to the market and a lot more.

- Had created an interactive dashboard using Microsoft Power BI, that can minimize the time and effort in incorporating the functions within the Dashboard, such as benchmarking providers, by simply choosing the provider, and then further drill down within the same page, giving a graph of the utilization per month, and which items are most utilized, and comparing the data per year.

- Have also created a trigger master specific to the region, that incorporates the findings and patterns in order to be applied to audits on providers in sequence, and even new joiners or inexperienced analysts can follow to either ease the journey of analysis or mainstream the process and speed up the workflow.

- Had created specific Excel workflows utilizing VBA (Visual Basic Application) to automate repetitive tasks, such as billing patterns, ICD & CPT billing anomalies .etc.

- Been involved in offsite and onsite audit journeys, visiting and interacting with the provider, communicating with the insurance department, questioning the physicians of identified trends and practices, requesting and auditing files, either as an open or closed file review.

- Been responsible of communicating with other stakeholders, being Management, Pre-Approval, Claims, Business Development, Network, Automation team and Project managers, communicating the findings and provide the stakeholders with recommendations for actions, what would be the expected impact, and expected results.

- Preparing and sharing reports through either Microsoft Word, Powerpoint or Excel, and in PDF format depending on the nature of the required report and requesting entity, internal or external.

- Have developed and maintained Dashboards and Trackers utilizing strong knowledge in excel.

- Playing my part in the recovery process, verifying reports, insuring accuracy, discussion and negotiations with the providers along with the Network team.

- Been part of stakeholders meetings providing insights or proper strategic planning and approach to providers and situations.

- Through strong medical knowledge, assisting the Global Allianz colleagues with medical and billing queries, and practices and regulations within the GCC market

• Company Overview: Previously AXA Gulf, Bahrain Bay, Bahrain
• Functioning as Team Leader, having my own team, following up with their production, quality, audit, and areas of improvement, and their performance in general, monthly and occasional meetings to insure their improvement and quality and they are being comfortable
• Alongside, managing shift load distribution of received cases, insuring TAT (Turn Around Time), validating requests that are above limit, or out of network, or overriding general exclusions etc
• Responding to team queries during shift to insure work flow
• Responding to emails, being from client, broker, complaint team (DHA or HAAD or regulatory complaints), or customer service emails
• Regular review of guidelines for the whole team, as well as conducting assessments over guidelines
• Previously AXA Gulf, Bahrain Bay, Bahrain

• Functioning as a Pre-Approval Medical Officer, handling and evaluating requests from different specialities, inpatient and outpatient, focused more on Surgical, and Medical Cases, and Handling IP COVID-19 cases, answering calls from clients, brokers and providers, and responding to emails, being complaints or explaining reasons of rejection .etc

• Functioning as surgical resident, evaluating patients prior to surgery, pre-operative preparation, assisting in operation theater, caring for patients post operatively, and dealing with complications when on call
• Have assisted in different operations, in different specialities

• Rotating in different departments, major and minor, different specialities, scoring an outstanding evaluation