Mohammed Mirshad Chelapram Kandy

senior network officer

• Job Details:managed and expanded provider network through hospital contracting and pricing negotiations. led drg and cpt coding structure implementation for efficient billing and reimbursement. conducted yearly volume rebate calculations, recovering aed 500k+ in additional revenue. maintained pricing and provider data accuracy across systems to support operational integrity. handled complaints from both providers and insured members via root cause analysis and resolution strategies. delivered educational webinars and conducted site visits to strengthen hospital relationships. supported cost containment projects with utilization reports and benchmarking analysis.

manager – network & claims

• Job Details:managed hospital claims and provider operations for better financial performance. audited healthcare providers to identify fraud, waste, and abuse (fwa). implemented corrective action plans to improve compliance and billing transparency. trained teams on proper adjudication practices and managed hospital-facing escalations.

claims doctor

• Job Details:reviewed medical claims for accuracy and benefit alignment. liaised with providers to resolve disputes and improve documentation processes.