DR. JAWAD AHMAD
El-Erfan Street, Al-Ruwais Dist-2. Jeddah. Saudi Arabia.
Mobile: 00966-549863328.
Email: drjawadahmad@gmail.com
Experienced in a Multi Specialty family medical practice in Emergency, Trauma & Orthopedics having additional
healthcare experience as Manger Health Insurance. Seasoned in Operation & Customer services focused
professional with comprehensive Health Insurance business consulting.
More than 5 years of Experience in Provider Contract Management & Networking, Health Insurance Operations &
Claims Management, MIS, Customer Services in areas of Operations, Healthcare Financing & Health Insurance.
Specialist known for dedication in providing premium customer support & patient care. Skills include:
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Manipulation of Joints
Fracture Reduction with
Splints & Plaster
Hand & Foot Surgeries
Hip & Knee Replacement
Surgeries
Bone, Vessel & Skin Grafting
— HMO & POP Insurance
Protocols
— Medical Approvals &
Authorizations
— Reimbursement &
Reconciliation Claims
— Auditing, Encoding &
Networking Techniques
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OPD Practice
Minor to Major Surgical
Injuries
Medical Emergencies
CPR, Intubation &
Resuscitation
Critical Care
Education
2014-2015
1995-2000
1993-1994
1991-1992
CHARTERED INSURANCE INSTITUTE (UK)
CERTIFICATE CII (Expected)
BAQAI MEDICAL COLLEGE & UNIVERSITY.
BACHELOR OF MEDICINE & SURGERY (M.B.B.S)
D.J.SCIENCE COLLEGE. HIGHER SECONDARY CERTIFICATE (Pre-Med).
CADET COLLEGE KOHAT. SECONDARY SCHOOL CERTIFICATE (Science)
Professional Experience
THE CLINIC — Karachi, Pakistan
General Medical & Surgical Doctor, 1st February 2014 – Till Date
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Private practice of OPD.
Management of Orthopedically Cold Cases.
Management of Fractures with Splints, Bandages & Plasters (P.O.P * Scotch / Dyna Casts)
Management of Acute Minor / Major Surgical Injuries.
Application of Sutures / Wound Debridement & Nail Removals.
Circumcision of Neonates by Ring Method.
Screening of Hepatitis & other problems.
Skin Grafting
Management of Hand injuries of Industrial Trauma.
Management of Acute Medical Emergencies.
ASIA CARE HEALTH & LIFE INSURANCE COMPANY — KARACHI, PAKISTAN
Manager – Medical & Claims management, 18th July 2013 – 31st Jan 2014.
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Analyzed provider hospitals network usage from time to time on periodic basis, Network planning &
development of providers for a Giant Corporate Client “TELENOR Pakistan” & other Corporate,
individual, retail & micro insurance clients coverage for creating an effective Authorization & Claims
system by practically implementing 24/7 customer care, through hotline management handling
personally for customer support, queries, health issues, disorders, diseases, policy coverage &
assistance of network providers throughout Pakistan.
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Maintenance of Tariff negotiation, schedules & discounts with network provider’s i.e Multi-specialty
hospitals, Super specialty hospitals, Low cost hospitals & Diagnostic centers for corporate, retail &
micro insurance clients by region / city basis throughout Pakistan.
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Compilation of Authorization & claim reports, statistical data & MIS reports of Individual, Retail &
Corporate clients on continuing basis, SLA & PWA adherence to help monitor assigned services
operations & implementation and compliance measures to various protocols as per Quality norms.
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Supervised claim processing team: Manage reviews & resolve claims including medical billing process,
determine course of action, developing arguments & addressing claimant’s rebuttals, conducting
preliminary negotiations & preparing & issuing notices to claimants.
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Maintaining Excellent standard of Case Management as working in close relations with the network
providers Consultants & Doctors of various specialties to evaluate & analyze clinical aspects of care in
order to improve quality of patient care & plan for better in cost effective tariff.
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Attend all the clients/customers concerns, complaints, grievances & take necessary steps for services
delivery, reconciliations, recovery issues & resolutions minimizing escalation.
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Submission of monthly KPI’s & PPI’s to the Operational Head, in respect of Authorization & Claims.
GREAT EASTERN LIFE INSURANCE COMPANY (M) Bhd — PAHANG, MALAYSIA
Manager Health Insurance Audit, 05th April 2012 – 15th July 2013.
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Managing Health Insurance services for Domestic & International Corporate Clients, Insurance Clients,
Brokerage & Retail Groups.
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Coordination & Laisioning with other Insurance Companies, TPA’s & Government Statutory Bodies
(State Government & Finance Ministry etc) for smooth operations i.e Networking, Claims Management,
Bill Settlement & Compliance.
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Supervised initial scrutiny audits of new business appliances in view of requests & complaints to ensure
process adherence meet targets i.e Regular monitoring TAT and SLA. Audit the claims management
function of appointed TPAs. Development & maintenance of standard operating procedures (SOP) as
laid out in the ISO Procedure & Standards.
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Monitored provider performance (Preferred Provider Network) to improve overall quality & efficacy
including cost saving through network providers vs non-network hospitals trough in- house team of
Case Managers & with allocated TPA’s.
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Maintained MIS report of corporate clients on premium analysis, claims settlement ratio, TAT for claim
settlement, outstanding claims analysis & Re-imbursements.
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Performed claim experience analysis, claims savings, claims development studies, risk analysis & fraud
analytics. Assisted in overall case resolution strategies, settlements & litigation support.
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Conducting internal audit of claims/authorization and external audit of providers to evaluate the
insurance policies & regulations are abided.
ADAMJEE INSURANCE COMPANY — KARACHI, PAKISTAN
Assistant Manager – Medical management, 16th May 2011 – 5th Jan 2012.
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Supervision of Claims Management activities in department of health insurance.
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Making of Portfolio, Strategic plans and Strategies for implementation in Claims Department as per the
PWA & table of Benefits.
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Resolving complex situation of Pre Authorization & Approvals using service oriented handling
methodology.
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Directing the implementation of any effective, consistent service structure and overseeing claim
administration
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policies and procedures to augment in day to day operations.
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Monitoring daily Hospital admission as well as performing concurrent review in hand.
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Reconciliation, negotiation and discussion of already rejected claims with the broker company,
providers and the client.
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Hold disease management sessions & maintain relationships with clients & panel hospitals.
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Assist the medical writing department in submitting quotations to the clients and general inquiries
AL KHAZNA INSURANCE COMPANY P.S.C — ABU DHABI, UAE
Senior Medical Officer, 20th June 2010 – 20th March 2011
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Handling overall Health Insurance Claims Management activities.
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Making of Portfolio, Strategic plans and Strategies for implementation in Claims Department as per the
PWA & Table of Benefits.
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Resolving complex situation of Pre Authorization & Approvals using service oriented handling
methodology.
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Directing the implementation of any effective, consistent service structure and overseeing claim
administration policies and procedures to augment in day to day operations.
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Final auditing of the direct & reconciliation claims up till the medical statement boudurex of medical
claims. (Paper & E Claims)
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Reconciliation, negotiation and discussion of already rejected claims with the broker company, provider
and the client.
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Overall management of work compensation and reimbursement claims.
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Assist the medical writing department in submitting quotations to the clients and general inquiries.
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Management of Networking and Authorization Department for day to day operations.
FOSTER NET T.P.A LLC (Formally Musallah NET T.P.A LLC) — Dubai, UAE
Specialist Insurance General, 1st March 2009 – 10th March 2010
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Handling overall Health Insurance Management activities.
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Making of Portfolio, Strategic plans and Strategies for implementation in Claims Department.
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Resolving complex situation of Pre Authorization & Approvals using service oriented handling
methodology.
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Directing the implementation of any effective, consistent service structure and overseeing claim
administration policies and procedures to augment in day to day operations.
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Final auditing of the direct & reconciliation claims up till the medical statement boudurex of medical
claims.
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Reconciliation, negotiation and discussion of already rejected claims with the broker company, provider
and the client.
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Overall management of work compensation and reimbursement claims.
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Assist the medical writing department in submitting quotations to the clients and general inquiries.
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Management of Networking and Authorization Department for day to day operations.
ROYAL CLINIC & DIAGNOSTICS — Karachi, Pakistan
General Medical & Surgical Doctor, 1st February 2008 - 10th February 2009
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Private practice of OPD.
Management of Orthopedically Cold Cases.
Management of Fractures with Splints, Bandages & Plasters (P.O.P * Scotch / Dyna Casts)
Management of Acute Minor / Major Surgical Injuries.
Application of Sutures / Wound Debridement & Nail Removals.
Circumcision of Neonates by Ring Method.
Screening of Hepatitis & other problems.
Skin Grafting
Management of Hand injuries of Industrial Trauma.
Management of Acute Medical Emergencies.
FIDAI EMERGENCY MEDICAL EMERGENCY CENTER — Karachi, Pakistan
Medical & Surgical Officer, 1st March 2007 – 1st February 2008
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Management
Management
Management
Management
General OPD
Management
of
of
of
of
Medical Emergencies
Surgical Emergencies
Road Traffic Accident
Minor to Major Household Injuries
of Monitor to Medium Orthopedic Fractures & Injuries
IMAM CLINIC & GENERAL HOSPITAL — Karachi, Pakistan
Operation Theater Manager, 3rd September 2006 – 20th February 2007
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Infection Control
C.S.S.D
Inventory & Supplies
Audit of Surgical Items
Scrub in cases of Assistance
Coordination between Surgeon and Anesthetics.
A.O CLINIC (HOSPITAL FOR BONES & JOINTS) — Karachi, Pakistan
Resident Medical Officer (Operation Theater), 1st August 2005 – 30th July 2006
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M.U.A & P.O.P cast of Joints & Fractures
Skin grafting
Cross leg & Cross arm flaps
V.Y Plasty of Fingers
Removal of metal
Syme’s Amputation
Different kinds of Amputation
Diabetic foot
Hemi Arthroplasty
Management of Compound Fracture
Inventory & Supplies
Bone grafting
Vessel repair
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O.R.I.F
Limb re-implementation surgery
Wound Debridement
K-Wire Fixation
Management of Polytrauma Patient
THE UNIVERSAL INSURANCE COMPANY — Karachi, Pakistan
Medical Consultant & Adviser, 18th August 2004 – 30th January 2005
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Approval and disapproval of Intimations
Revision & Final Settlements of bills / claims
Enlistment and de-enlistment of Panel Hospitals
Visit to patients at Panel Hospitals
Settlement of rate list with panel hospital
ZAINAB PANJWANI HOSPITAL, IMAM CLINIC & P.E.C.H.S TRAUMA AND GENERAL HSPITAL — Karachi,
Pakistan
Assistant to Orthopedic Surgeon Dr. Nooruddin, 1st June 2003 – 30th June 2004
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Thrice a week Consultation
Examination of patient during Consultation
Manage Emergencies & Trauma
Manipulation & Local Anesthetic Surgeries
To assist the consultant in major surgical procedures in O.T
IMAM CLINIC & GENERAL HOSPITAL — Karachi, Pakistan
Casualty Medical Officer (Evening), 27th February 2003 – September 2004
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Manage with Medical & Surgical Emergencies in Casualty
Manage with Road Traffic Accidents & Trauma
First Aid Management
Admission of Serious Patients
ABBASI SHAHEED HOSPITAL — Karachi, Pakistan
Resident Medical Officer (Honorary) Department of Orthopedics, 10th November 2002 – March
2003
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Managed OPD’s twice a week
First Aid Management of Casualty in Department
Manipulation & Local Anesthetic Surgeries
Assisted the Consultant in Major Surgical Procedures in O.T
DR. RAFAT’S ENT CARE CENTER — Karachi, Pakistan
Emergency Medical Officer, September 2002 – December 2003
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Manage with Medical & Surgical Emergencies in Casualty
Manage with Road Traffic Accidents & Trauma
First Aid Management
Patient’s care & management in Wards.
O.P.D
ALTAMASH INSTITUTE OF DENTAL MEDICINE — Karachi, Pakistan
Demonstrator in Department of Bio Chemistry, 24th September 2002 – 5th November 2002
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Demonstrate Biochemistry Practical in Lab.
Offered Lectures of Biochemistry
Taking Tutorials
Preparation of MCQ’s
MEDI COMPLEX HOSPITAL — Karachi, Pakistan
Casualty Medical Officer / Resident Medical Officer, April 2002 – August 2002
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Manage the Medical & Surgical Emergencies in Casualty
Intensive Care Unit Management
Patient’s care & management in Wards.
O.P.D
KULSOOM BAI VALIKA S.S SITE HOSPITAL — Karachi, Pakistan
Senior House Officer (Surgery), February 2002 – August 2002
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Regular O.P.D’s
Management of 30 bedded MALE SURGICAL WAZRD
Management of 20 bedded FEMALE SURGICAL WARD
Management of 10 VIP Room
Casualty Medical Officer for two days in each week
Performed Minor Surgeries like Hernia, Hemorrhoids, Varicocele, Hydrocele, Circumcision, Appendix,
Pilonidal Sinus and Fistulas etc.
Performed all types of local Anesthetic Surgeries.
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KULSOOM BAI VALIKA S.S SITE HOSPITAL — Karachi, Pakistan
Senior House Officer (Medicine), March 2001 – February 2002
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1999
Regular O.P.D
Management of 50 bedded MALE MEDICAL WARD
Management of 20 bedded FEMALE MEDICAL WARD
Management of 10 VIP Rooms
Intensive Care Unit Management
Hemodialysis & Endoscopies
NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASES.
HONORARY ELECTIVES FOR 2 MONTHS.
Supervision of DR. ANIS MEMON.
Emergency management of cardiac patients.
E.C.G., E.T.T. & Echocardiography.
Angiography & Angioplasty.
1998
NATIONAL INSTITUTE OF CHILD HEALTH.
HONORARY ELECTIVES FOR 2 MONTHS.
Supervision of DR.AZIZ AHMAD.
Basic child health diseases.
Expended Program of Immunization.
Neonatology & Daycare.
Research Project
1998-1999
SURVEY ON KIDNEY TRANSPLANTATION IN
THREE MAJOR CITIES OF PAKISTAN.
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Supervision of PROF.DR.THAVER.
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Department of community medicine, Baqai Medical College.
Research & Development Projects
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EFFICACY AND SAFETY OF LIVERGIN (Herbal Medicine) IN ACUTE VIRAL HEPATITIS.
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Supervision of PROF.DR.SHAHAB ABID.
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Presented in PAKISTAN SOCIETY OF PHYSICIANS KARACHI, 16TH ANNUAL SYMPOSIUM on MAY 25-26,
2001 at LIAQUAT NATIONAL HOSPITAL.
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CME Credits from Dannemiller Memorial Education Foundation, San Antonio, Texas, United States.
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The Aga Khan University Seminar on prevention of Hepatitis B virus infection on April 9, 2001. (CME 5
Hours)
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The Aga Khan University Seminar of update on Gastroenterology on August 28, 29 & 30, 2001. (CME 9
Hours)
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The Pakistan Cardiac Society Workshop of Unstable Angina Pectoris / Non ST Elevation Myocardial
Certification & Seminars
Certification & Seminars
BRAIN BENCH CERTIFICATION
FROM:
Brain Bench (UK)
Web site: http://www.brainbench.com
Transcript ID: 2495718
CERTIFIED BY BRAINBENCH IN ANATOMY AND PHYSIOLOGY, MEDICAL TERMINOLOGY AND PHYSICAL ASSESMENT
TECHNIQUES.(ADULT)
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4th Critical Care Congress on 20th September 1996.
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2nd Biennial Symposium on “Assisted Reproduction” on 19th July 1997
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5th Critical Care Congress on 12th & 13th September 1998.
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4th Annual Hamdard Symposium on 12th to 14th December 2003.
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5th LNH Symposium on 21st to 25th January 2004.
Licensure & Membership
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Full registration with PAKISTAN MEDICAL AND DENTAL COUNCIL.
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Registration No: 39543 – S
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MEMBER PAKISTAN MEDICAL ASSOCIATION.
Languages
ENGLISH
 ILETS Preparation Course from BRITISH COUNCIL KARACHI.
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ILETS ACADEMIC MODULE Test results overall band 7.0 (2005)
URDU
 Spoken and Written.
PASHTO
 Understanding and Spoken
Computer Education
OPERATING SYSTEMS.
 WINDOWS 7 & 8
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WINDOWS 2008 R2
APPLICATION SOFTWARES.
 Microsoft Office 2010 & 2013
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Jupiter Business Manager.
Personal Details
Full Name: Dr. Jawad Ahmad
Permanent Address: B – 21, Block “L”, North Nazimabad. Karachi. Pakistan
Nationality: Pakistani
D.O.B: 06th November, 1975.
Religion: Islam
Height: 5 feet 11 inches
Passport # NK1156042
Visa: Work Permit / Transferable.
N.I.C # 42101-3128604-7
References
To be produced on demand.