Dr. GALAL RASHWAN
Mobile: +966 0567141226
+2 0171113489
Citizenship: Egyptian
Date of Birth: 01/11/1960
Marital Status: Married
Country of Residence: KSA
Email: galalrashwan@yahoo.com
Objective:
Over 18+ years of strong experience in analysis, design, development and deploying Business solutions
of health care industries and health insurance programs, sharing in strategic planning either private
or/and governmental for the health care resources, control and driving locally and globally.
Education:
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Health Insurance Association of America “HIA” in health insurance and
long-term disability /2002.
Certificate in insurance “Cii” at Chartered Insurance Institute/ London/
2004
Certificate in the anti-money laundry (AML) & Compliance at Thomson
Reuters Institute accredited by the Chartered Institute of Securities and
Investments, 2011
Individual Scope of Approval from Qatar Financial Center (QFC), for
Senior Management Function in Health &Life insurance business, 2011
Certificate of participation in Healthcare Services Management, at
SETTEC training house Cairo, Egypt, 2008
Certificate of Cardiopulmonary Resuscitation at Saudi Heart Association,
KSA, 2012,
CME at Mayo Clinic and Cleveland medical schools USA, 1998
MBBCH Medicine and Surgery Egypt/1988,
Certificate of Takaful Professionals (under processing).
Associate in Australian Center for quality of life (ACQOL)
Registered in ERM, Enterprise Risk Management at Chartered Insurance
Institute of America USA,
Registered for Diploma in Life & Disability Underwriting (DLDU) at CII and
AMS/London. (Chartered Insurance Institute & Assurance Medical
Society/ London.),
Registered in Master& Diploma in Surgery, Egypt.
Languages:
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Excellent English& Arabic
Fair Germany & French
Work Experience:
Malath Co-operative Insurance & Re-insurance Co (KSA/Riyadh)
[Jul 2012 – Present]
Senior Manager Health& Life Insurance Operations
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Accomplish business development objectives by establishing business &
action plans, budgets as well as key performance indicators and provide
a suggestion and strategic revisions.
Development and refinement of a marketing strategy to grow the
business, improve awareness in the local market, lead and guide the
MRs to execute up on aforementioned strategy.
Manage & operate the group life and credit life portfolio
Manage & operate the corporate/ retail health insurance solutions
Health Insurance Expert in insurance market (Egypt/Cairo)
[Feb 2012 – Jul 2012]
Expert & Analysis Health& Life Insurance industry in Egypt
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Dr. GALAL RASHWAN
Mobile: +966 0567141226
+2 0171113489
Citizenship: Egyptian
Date of Birth: 01/11/1960
Marital Status: Married
Country of Residence: KSA
Email: galalrashwan@yahoo.com
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Survey of the health insurance industry in Egypt market
Built up TPA business for proper health insurance management in special
& aggressive market like Egypt.
Q Life & Medical Insurance Company QLM
[October 2011 – Feb 2012]
Chief Operating Officer of QLM
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A locate and propose potential business deals by contracting potential
partners, discovering and exploring business opportunities.
Coordinate the financial & budget activities to fund operations in order to
determine weak and strong points and the areas that need the cost
reduction and business improvement,
Develop and maintain strong mutual relationships with the existing
corporate and retail customers schedule and attend meetings to
understand the nature of clients and business opportunities.
Manage & operate the group life and credit life portfolio
Manage & operate the corporate/ retail health insurance solutions
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Qatar Insurance Company (Qatar / Doha)
[Oct 2002 – September 2011]
Senior Vice President- Medical Insurance
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Built up the medical insurance department of QIC, through marketing
survey, segmentation and technical & financial visibility study for the
project through Qatari market.
Establishment in-house claim services unite to deal with the CR & direct
billing medical claims.
Establishment organized local and international call centers assisted
with a professional staff members 24 / 7
Establishment an underwriting unite deal with all health insurance risks
(basic or supplementary) on a full retention basis,
Establishment a network providers local, regional and global.
Establishment Takaful medical product for BEEMA, (Damman Islamic
Insurance Company Doha, and built up the reinsurance treaty for that
product.
Training of the department staff members and the administration
members at the providers.
Design the standard QIC health insurance plans (Classic, Advantage,
and Premier),
Tailored the group health insurance plans to the governmental firms and
major groups through open tender,
We serve more than120 clients (60 thousand insured) with portfolio of
120 million Qatari Riyal as health insurance portfolio.
The incurred loss ratios thru past underwriting period varied between
62%-28%
National Co-operative Company of Insurance NCCI/ Tawuniya
(KSA/Riyadh)
[Sep 1998 – Sep 2002]
GROUP LEADER QUALITY &STANDARDS REVIEW AT THE HEALTH
INSURANCE DEPARTMENT, NCCI/ KSA
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Create the policy & procedures for the following:
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Dr. GALAL RASHWAN
Mobile: +966 0567141226
+2 0171113489
Citizenship: Egyptian
Date of Birth: 01/11/1960
Marital Status: Married
Country of Residence: KSA
Email: galalrashwan@yahoo.com
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 Contracting Management for the new contracts and renewed
contract
 Quality & Standards Review
 Quality Assurance
Evaluation of the appointed provider through the international or local in
house evaluation scheme
Member of the provider control and contracting Committees in taj
medical insurance at NCCI.
Provide the statistics, data and advice for the underwriting.
Develop the policy wording, Professional definitions and eligibility and
final review of the issued policies and the appointing letters along with
table of benefits to the appointed providers.
Help in risk evaluation and risk control
Evaluation, survey and structure the benchmarking for the health
services at the health care organizations.
Support the strategy for managed care and long-term care plan
Survey and studying the lapsed policies and surveying the account
about the standards of services either at the insurers or the providers
Support the brokerages, account’s owners and consultant’s offices by
the actuarial data and statistics
Create and develop the fraud control committee to follow, detect and
determine the fraud incurred by the health providers or/and by the
insured.
Reviewing the growth of business size with the provider and monitoring
in their behavior quarterly.
Classification and banding of the appointed provider network subject to
the level of standardizations for each provider.
Support the coding and development of the system in NCCI and
evaluate and tailor the pilot provider for the auto transactions program
(waseel).
Create and structure of the net–payment of medical services through
developing the package deal agreement and special deal for the critical
cases
Control the loss through
 Monitoring the highly severity and frequency of claims
 Minimizing the administration cost of claims
 Creation of the provider’s liability in the claim cost
 Development of the managed care system
Confirm the application of Standards & Quality with Client and providers
through:
 Development of unified formats, scenario between the insurer and
the PPO- network
 Solving the client complaint at the provider network
 Follow up the application of the policy wordings and the contract at
the appointed providers
Merging with claim administration and accounts owner and other
insurers to develop the coordination principle of the liability.
Handled all paperwork from preliminary conversations with policy
holders.
GROUP LEADER APPROVAL CENTER, MANAGED CARE& CASE
MANAGEMENT AND INTERNATIONAL MEDICAL ASSISTENCE AT
THE HEALTH INSURANCE DEPARTMENT, NCCI/ KSA:
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Dr. GALAL RASHWAN
Mobile: +966 0567141226
+2 0171113489
Citizenship: Egyptian
Date of Birth: 01/11/1960
Marital Status: Married
Country of Residence: KSA
Email: galalrashwan@yahoo.com
[Sep 1996 – Sep 1998]
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Planning for automation at the approval center and develop the server
to manage the approval format electronically from and to the provider
Expansion of providing the medical services through the world wide
network including MEDEX and World care Corporations
Monitoring the frequencies & severity of the medical claims
Put planning to collect all figures and data about the paid and
outstanding claims, reserved claim and IBNR claims
Collect the data about the client and provider behavior and put the
procedure to control the business
Create the Field Doctor team to follow the provider’s behavior and
communicate with the approval center personal to provide required
data about both incurred and life claims.
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OPERATION OFFICER AT THE HEALTH INSURANCE DEPARTMENT,
NCCI/ KSA:
[Sep 1994 – Sep 1996]
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Follow up the major inpatient claim at the medical provider
Put the strategy for evaluation, management and monitoring the
claims received at the approval center
Communicate between the approval center and the Claim services
department
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EXPERINCES & RESPONSIBILITY IN THE MEDICAL FIELD:
[Sep 1988 – May 1994]
Medical Practitioner:
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From 13/10/1994 to 03/06/1995 as General Surgery Resident and
Hospital director at Al-Hammadi Hospital for operation &
management/ KSA.
From 01/09/1990 to 01/10/1994 as General Surgery Resident at
Mahala Kubra General Hospital – Ministry of Health / Egypt.
From 01/09/1989 to 31/08/1990 as OB&Gyne Resident at AlAluminum Co Hospital In the ministry of industry / Egypt.
From 01/09/1988 to 31/08/1989 as house officer in Tanta University
Hospital / EGYPT.
Computer Skills:
MS Office (Excel, Outlook, Word, PowerPoint), and excellent research
skill using the Internet
Interests and activities:
Reading, Traveling, Tennis, and Squash.
References:
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Mr. Mousa Al Rubaian X-NCCI MD/ KSA & Chairman Dar Mousa for
Insurance Consultancy, Riyadh/ KSA
Mr. Moomen Mukhtar, Reinsurance G. Manager NCCI/ KSA
Mr. Saleh Al Omair X-NCCI/ KSA, GM Amana Insurance KSA
Mr. Khalifa Al Subai President CEO QIC Holding
Mr. Ahmed Yousef Senior Advisor QIC Group.
Mr. Ali Al-Ayed CEO Malath Insurance/ KSA
Mr. Nasser El Bunni, EVP Finance&Strategy Malath Insurance/ KSA
Mr. Donald Johnson, EVP Technical Malath/ KSA.
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