Mansour Sheleg

  •                                                  AL-Furnaj, Tripoli, LIBYA (Currant).                   38 Brehon Grove, Kingston, Dublin16 (Perminant).                                                               

Provider Services Executive

Summary

Qualified Medical Doctor , with more than two years of practical experience in health insurance and Health care  industry working with  local and an International Medical Insurance Companies

Work History

Work History
May 2014 - Mar 2015

Provider Services Executive

TakaFul Insurance Co.

Allianz Worldwide care acting through her partner in Libya Takaful Insurance Co.

The role was with the core responsibility for developing direct billing relationships with Hospitals and medical practitioners throughout Libya , Dealing with providers concerns and service issues in terms of ( Pricing,Price Revisions,Services additions)

Key Responsibilities

  • Continuous development of the Allinz Worldwide Care provider network in Libya.
  • Manage face to face meetings with Providers in their territories and manger their performance
  • Develop strategic relationships with TPA’s and Providers throughout Libya
  • Negotiating with Providers in order to enter into contracted relationships with Allianz Worldwide Care.
  • Negotiate Direct Settlement agreements with Providers, where possible using the Allianz Worldwide Care standard contract.
  • Negotiate % Discounts with the Provider.
  • Produce reports and updates regarding the progress of targets in weekly basis to the head office in Dublin.
  • Ownership for Provider data, ensuring data accuracy which provides the basis for sound Business decisions.
  • Working across departments to resolve provider related service issues, owning and managing issues to closure.
May 2013 - May 2014

Medical Services Advisor 

Operations Libya For Health Care Management 

Operations Libya Co. Act as a TPA Company , taking the administrative part of insured people of different insurance policies .

Key Responsibilities

  • Preauthorization of in-patient treatment.
  • Aggressive cost containment through tight adjudication, correct evaluation of medical appropriateness and successful negotiation.
  • Case management of complex cases.
  • Maintain relationships with brokers/clients/providers.
  • Medical claims reviews
  • Support a 24 x 7 service to our Clients
  • 24 x 7 helpline
  • Abroad arrangement and case evacuation 

Education

Education
Oct 2006 - Aug 2014

Bachelor of Medicine and Bachelor of Surgery (MB ChB)

Tripoli Universty

Skills

Skills

Gobal work Performance

Setting up and developing a direct billing network of medical providers for Allianz Worldwide care in Sudan and south Sudan . to met the needs of one of the AWC biggest client  FAO , WFP

Provider Relations

Negotiate Direct Settlement agreements with Providers (Hospitals, Clinics and Consultants) across the Country .

Medical Case Management

  • Approval or denial of claims based on policy terms & conditions
  •  Dealing with international cases, arranging direct billing for members abroad.
  • Abroad arrangement and case evacuation 

Writing and Reporting 

  • ( Health Care in volatile environment ) was published in Allianz Medical newsletter .
  • Presentation ( Libya overview  ) in the yearly  Provider & medical team week in Dublin . 

Hospitals

I was involved in the implementation of Hospital Evaluation programs in Libya by Allianz Global assistant based in Paris , France , one of Allianz worldwide care sisters

Surgery

I am in attachment program in General surgery Department at Abusalim Trauma Hospital .

References

References available upon request.