Bahaa Mohammed
Kuwait City
Summary
Experienced Deputy Manager in Medical Claims with nearly a decade of expertise overseeing a diverse portfolio of medical claims across multiple Gulf markets. Demonstrated success in leading large teams and executing complex projects, resulting in operational excellence and streamlined claims processes. Skilled in health insurance, strategic planning, stakeholder management, budgeting, governance, and operational resilience. Proficient in policy development, implementing best practices, and optimizing procedures to enhance efficiency and elevate customer satisfaction. Strong leadership abilities in people management, negotiation, and liability handling, coupled with advanced proficiency in Microsoft Excel. Committed to delivering exceptional service through a proactive, solutions-oriented approach. Consistently achieves improvements in claims processing, approvals, and overall medical operations.
Overview
12
12
years of professional experience
18
18
Certification
Work History
Deputy Claims Manager-Medical Operations
Gulf Insurance Group
12.2022 - 12.2024
- Oversee the claims operations of a geographically dispersed team of40+ professionals across multiple countries, ensuring efficient and effective claims processing under one of the largest medical policies in the Middle East
- Successfully manage high-volume claims operations in a high-stress environment, maintaining operational excellence despite heavy workloads and complex claim scenarios
- Ensure the timely and accurate processing and settlement of claims, maintaining strict quality control and adherence to regulatory and policy requirements.
- Lead strategic projects aimed at enhancing claims processing efficiency and operational effectiveness, applying advanced analytics to streamline workflows and performance monitoring
- Lead the resolution of escalated or complex claims, leveraging deep expertise in claims operations to address issues promptly and enhance customer satisfaction
- Develop, implement, and refine claims operations policies, procedures, and best practices to drive efficiency, mitigate risks, and ensure compliance with industry standards
- Utilize advanced analytics to monitor and report on claims performance, providing insights into trends, key metrics, and areas for operational improvement
- Collaborate with medical operations, underwriters, and other key departments to enhance claims processes, ensuring seamless integration and alignment across all functions
- Mentor and guide claims personnel, focusing on skill development and professional growth to strengthen the overall capabilities of the claim’s operations team
- Proactively identify and resolve operational challenges within the claims department, ensuring smooth workflow and continuous process improvements
- Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
- Enhanced customer satisfaction with timely and accurate claims resolutions.
Assistant Claims Manager
MedNet - Global Healthcare Solutions LLC
07.2022 - 12.2022
- Support the Claims Team Leader in overseeing the claims and approvals processes for the Dubai and Oman offices, ensuring smooth and efficient operations.
- Monitor team performance to exceed 100% of KPI's, workload distribution, and operational challenges, providing regular reports and insights to leadership for informed decision-making
- Offer guidance, feedback, and continuous development opportunities to team members, fostering a culture of growth and excellence
- Serve as a key liaison between the team and senior management, including the Hub Manager, General Manager, Regional HR, and other key stakeholders, ensuring clear communication and alignment of objectives
- Led the coordination of medical operations projects aimed at streamlining and optimizing claims and approvals processes, driving improvements in operational efficiency
- Monitored departmental budget, making adjustments as necessary to optimize resources for maximum results.
- Analyzed complex claims data to identify trends and recommend improvement strategies for future operations.
- Coordinated multidisciplinary teams across various locations to achieve cohesive project execution from planning through completion stages.
Claims Team Leader
MedNet - Global Healthcare Solutions LLC
07.2020 - 07.2022
- Ensure the quality and timeliness of the team’s work, as well as the compliance with the company’s policies and standards
- Coordinate with the hub manager and other stakeholders to resolve any issues or queries related to the claims and approval
- Directed claims negotiations within allowable limit of +20K AED and supported successful litigations for advanced issues.
- Identified areas for process improvement, leading to increased efficiency and reduced operational costs.
Acting HUB Manager
MedNet - Global Healthcare Solutions LLC
04.2021 - 07.2021
- Supervise claims and approvals teams, providing offshore support to the Dubai and Oman offices, ensuring consistent and high-quality service delivery
- Effectively managed medical operations during the transition period, maintaining operational stability and uninterrupted service throughout the change
- Oversaw daily operations, managing staff schedules, task assignments, and workflow prioritization for maximum productivity.
- Cultivated a positive work environment by fostering open communication, addressing employee concerns proactively, and promoting teamwork across all departments.
- Streamlined hub operations by implementing efficient processes and procedures.
- Coordinated cross-functional teams for seamless execution of projects and initiatives.
Senior Medical Claims Officer
MedNet - Global Healthcare Solutions LLC
07.2019 - 07.2020
Reimbursement Officer
MedNet - Global Healthcare Solutions LLC
11.2017 - 07.2019
Network Officer
MedNet - Global Healthcare Solutions LLC
03.2017 - 11.2017
Claims Officer
MedNet - Global Healthcare Solutions LLC
05.2015 - 03.2017
Senior Pharmacist
El Ezaby Pharmacy
01.2013 - 03.2016
Pharmacist
Ali and Ali pharmacies
07.2012 - 12.2012
- Dispensed and supplied prescription medicines to patients, following the physician’s orders and the FDA guidelines
- Provided medication counseling and education to patients, explaining the proper use, dosage, side effects, interactions, and storage of their drugs
- Recommended over-the-counter medications, home remedies, and health maintenance tips to patients, as appropriate for their conditions
- Maintained accurate records of all medication orders, refills, and transactions, using barcode scanning systems and software
Education
Diploma - Advanced Approaches in Clinical Pharmacy
Ain Shams University
Cairo10-2012
Bachelor of Pharmacy - Pharmaceutical Sciences
Cairo University
Cairo07-2012
Skills
- Claims management expertise
- Strong decision-making
- Claims processing efficiency
- Team leadership
- Professionalism and integrity
- Continuous learning commitment
- Healthcare regulations
- Process improvement strategies
- Medical coding proficiency
- Project management experience
- Results-driven approach
- Financial analysis
- Deadline oriented mindset
- Workflow optimization techniques
- Quality assurance oversight
Accomplishments
- Build a big team of +60 staff members to handle Offshore business from Egypt for Dubai and Oman.
- Collaborated with team of IT & Production in the development of Many new products, systems and policies.
- Achieved 70% of the end to end claim processes automation with Dubai business.
- Achieved 99% Quality and cost containment by completing enhancing the core system and adding rules with accuracy and efficiency.
- Achieved 30% increase in team productivity by introducing new automation approaches for recurrent tasks and decentralization.
- Received the Mednet Star Award in 2018 the Claims Department.
- Used Microsoft Excel to develop inventory tracking spreadsheets to monitor department KPI's.
Certification
- Revenue Cycle Management (RCM) in Healthcare From Alison (Jan-2025)
- Ai for Managers from Microsoft & LinkedIn (Jan-2025)
- Corporate finance foundation from LinkedIn learning ( Dec-2024)
- Financial Modeling and Forecasting Financial Statements from LinkedIn learning ( Dec-2024)
- Quality Management Foundations from LinkedIn learning ( Dec-2024)
- How to Work Smarter, Not Harder: Save Time and Money and Increase Productivity from LinkedIn learning ( Aug-2022)
- Balancing Multiple Roles as a Leader from LinkedIn learning ( Oct-2021)
- Building High-Performance Teams from LinkedIn learning ( Jan-2021)
LANGUAGE
Arabic: Native.
English: Fluent.
Software
Mednext
Arcmate
Docusign
Interests
Insurance
Leadership
Finance
AI
RPA
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Deputy Claims Manager-Medical Operations
Gulf Insurance Group
12.2022 - 12.2024
Assistant Claims Manager
MedNet - Global Healthcare Solutions LLC
07.2022 - 12.2022
Acting HUB Manager
MedNet - Global Healthcare Solutions LLC
04.2021 - 07.2021
Claims Team Leader
MedNet - Global Healthcare Solutions LLC
07.2020 - 07.2022
Senior Medical Claims Officer
MedNet - Global Healthcare Solutions LLC
07.2019 - 07.2020
Reimbursement Officer
MedNet - Global Healthcare Solutions LLC
11.2017 - 07.2019
Network Officer
MedNet - Global Healthcare Solutions LLC
03.2017 - 11.2017
Claims Officer
MedNet - Global Healthcare Solutions LLC
05.2015 - 03.2017
Senior Pharmacist
El Ezaby Pharmacy
01.2013 - 03.2016
Pharmacist
Ali and Ali pharmacies
07.2012 - 12.2012
Diploma - Advanced Approaches in Clinical Pharmacy
Ain Shams University
Bachelor of Pharmacy - Pharmaceutical Sciences
Cairo University
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