Maha Magdy Bassiouny

Bupa Global

• Claims management service managerFull Time

  Oct 2019 - May 2021 -1 yr, 7 months

  Egypt , Cairo

  • Job Details:• Forecast all staffing requirements and identify and resolve all issues effectively and schedule all employee attendance. • Completes performance reviews, recommends promotions and salary increases as required and in coordination with people/HR team. • Design selection criteria and manage recruitment and selection of staff for approved positions. • Lead, develop and mentor direct reports ensuring appropriate succession plans are developed. • Manage training and on boarding of new staff and liaise with other departments to ensure they have the required knowledge, skills and competencies to review & manage all outstanding claims. • Providing guidance, direction and professional advice to staff and senior management in investigation and resolution strategies for all medical insurance claims aspects in line with general insurance practice, regulatory compliance in addition to the company policies and procedures. • Monitoring adherence to policies and procedures for all aspects of claims handling by claims personnel, as well as assessing the quality of claims servicing, through defined claim file audits. • Analyze all claims and identify all associated risks and ensure processing of all claims as per company policy and in compliance with regulatory requirements. • Liaise with other members of global operations to ensure the continued & consistent development and timely updating of the Claims handling policies and procedures manuals. • Manages any corporate project initiatives on behalf of the claims department within the claims department
• Claims management consultantFull Time

  Apr 2017 - Oct 2019 -2 yrs, 6 months

  Egypt , Cairo

  • Job Details:• Ensuring claims are processed efficiently and correctly by working closely with insurers, loss adjusters, solicitors, brokers, claimants or their representatives, and relevant departments. • Investigating and auditing high cost claims reviewing reasonable and customary costs, eligibility, potentially fraudulent claims, negotiating prices with payers in accordance with company policy and procedures. • Ensuring complete and sound claim settlements, legal reviews and investigations in accordance with company policies and procedures • Case manage escalations and complaints from brokers, claimants, insurers or their representatives related to claims queries and manage any adjustments or exceptions required in coordination with any internal team. • Liaising with colleagues and other stakeholders to identify areas of improvements in claims policies and procedures manuals. • Team leader, representative and mentor for other colleagues.
• Customer service consultantFull Time

  Jul 2015 - Apr 2017 -1 yr, 9 months

  Egypt , Cairo

  • Job Details:• Ensure an exceptional customer experience for our customers by swiftly and accurately responding to and resolving all customer requests and queries. Customer contact will be across all communication channels phone, email, web chat and letter. • Approving/rejecting all requests to authorize treatment before any surgery or procedure. • Deal with all customer interactions in relation to policy subscriptions, reissuing and tracking member documents, manual collections and billing. • Take responsibility for ensuring that the system records reflect up to date communications with internal and external customers so that enquiries can be dealt with quickly and efficiently. • Handling members complaints and accordingly investigate situation and coordinate with other departments in order to solve the complaint in a timely manner and retain the customers.