nada sayed mohammed hassan

Medical claims processingFull Time

Quality SpecialistFull Time

• Job Details:August 2021 till now work as Quality specialist at Andalusia Remote office and these are may main roles: 1. Discipline measurement for different departments. 2. Monitoring of monthly, weekly reports. 3. Risk program Analysis. 4. Policy writing, workflows design and SOPs. 5. Work on many improvement projects using (FOCUS-PDCA). 6. OVR orientation sessions (as a trainer). 7. Investigation of reported OVRs to find root causes and take corrective and preventive actions. 8. when focusing on insurance department : *policy writing ex. MOH cases acceptance policy *monitoring of daily , monthly reports like : A/ MOH acceptance sheet that measure the TAT of informed , non informed cases tracking the reasons of rejection . B/ approval achievement sheet : to monitoring the TAT of approval process per agent . C/ monitoring & follow up : - submission & resubmission process. - % of rejected claims . - audit report that give us indication of % of expected initial rejection - % of claims reconciliated within 12 month . HR Department: 1. L&D: o OVR Orientation Sessions to all employee (existing & new hiring in onboarding process) o Schedule TNA for each department. o Prepare training material. o Measure training effectiveness (pre, post-test) o Review employee performance after training. o Recording online module as a guide. o Policy writing: internship policy. 2. Compensation & benefits: o Policy writing: sales bonus policy. 3. All HR sections: o Checklist to find gap in process and start improvement project. o HR index to be used as a tool to find all policies , workflow and authority matrix related to HR . 4. Recruitment : o Replacement authority matrix. o Onboarding policy & checklist. IT Department: 1. Policy writing: laptop policy. 2. Risk program: risks that occur in IT department and affects in call center.

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