Moustafa Hamdy

I am adept at handling multiple tasks on a daily basis competently and at working well under pressure.

 I joined AXA Life Insurance in Feb 2020  as Health Claims Officer 

my job responsibilities are 

validated the information on all medical claims 

Kept meticulous records of claims and follow up on lapsed cases.

Assessed the medical and financial assessment of the received claims.

Processed DLX (lab, radiology, physician and dental) health insurance claims.

Processed different types of claims based on the unit he/she is belonging to (outpatient, Inpatient, DLX, Reimbursement, pharmacy) .

Verified the claims service date with the received date and prior approval issue date for claims that needs prior approval .

Ensured that prior approval is issued according to policy. 

 Reviewed “claim form”, “medical card”, “required documents” and “providers’ bills” are original and meet our instructions and for the correct patient. 

Ensured diagnosis compatibility with the services performed. 

Reviewed policy notes, exclusions, limitations, comments and side pool if any.

Ensured claims match the coordination of benefits. 

 Issued reconciliation payment report for the provider and verifying the paid amount Vs the claimed amount in the provider statement .

Addressed the finance department to issue check for the provider. 

 Identified and reported any suspected cases of abuse or fraud to the quality team for investigation.

 Performed all other duties assigned by manager

Bachelor's Degree in Pharmaceutical Sciences graduated from Misr International University in Egypt