Amina Abi Oula Najjar

- Examining medical records and documents submitted for medical underwriting.
- Evaluate medical claims submitted from out TPA, and conduct quality assurance modalities.
-Acting Liaison for claims and disputes that might arise between insured members and Our TPA.
-Resolving work-related problems and preparing progress reports.
-Coordinating with other involved departments and parties to ensure quality service.
-Manage and restructure Table of Benefits based on the policy premium, and market needs.

Trained for three months by Medivisa/ Medgulf for health insurance claims processing (TPA) and acquired expertise about the Lebanese coding system, CPT codes, an ICD 10, this aid me in decoding the patient's diagnosis after discharge by thoroughly checking their case, surgical procedure performed, pathology results and course at the hospital.
-Utilize extensive background in identifying fraudulent insurance claims.
- Reviewing Clients’ Policies taking into consideration the Pros & Cons.
- Checking given approval for any misleads.
- Issuing Payment Vouchers after double-checking the deductions thoroughly.
- Use my acquired knowledge in ICD-10 and CPT coding and knowledge of NSSF & MOH compliance regulations.
- Reviewing medical claims, providing medical records to the appropriate personnel and conducting quality control.
- worked for 2 years in processing UNHCR claims based on preset policy conditions, and as per the MOH rules and regulations concerning the flat rates and guidelines.
- Audited and processed the MOH claims for 1 year.
-Audited claims for other Medgulf's claims and selected groups.