Sana Inoubli
Healthcare & Medical Insurance Professional | Case Management
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نبذة
Healthcare and medical insurance professional with a strong medical background in Anesthesia and Intensive Care and a Master's degree in Public Health Management. Solid experience in case management and precertification within an international environment, handling complex and sensitive cases while ensuring compliance, quality standards, and KPI performance. Recognized for process improvement, cross-team collaboration, and contribution to a consistent, customer-centric approach.
الخبرة
Medical Case Manager and Precertification Specialist - MSH INTERNATIONAL - Tunis
(2022-03)
- Manage and coordinate case management and precertification activities across multiple client portfolios (24/7 team), ensuring compliance with medical policies, procedures, and turnaround times.
- Handle hospitalization, maternity, emergency, and check-up cases, applying medical necessity criteria and a customer-centric case management approach.
- Review precertification requests, verify insured members' eligibility and benefits, and issue LOG via V9 in line with standard processes.
- Monitor open, sensitive, and complex cases, ensure follow-up until resolution, and escalate critical situations to Seniors or Management when required.
- Coordinate closely with healthcare providers, insured members, brokers, and internal medical, precertification, and operations teams to ensure continuity of care and service quality.
- Contribute to KPI achievement, process improvement, team support and training, while promoting a strong and consistent case management culture.
International Medical Claims Administrator - HENNER GMC - Tunis
(2021-12 - 2022-03)
- Processed reimbursement requests and approval submissions for insured members from OECD based international organizations.
- Reviewed medical documents and claims to ensure compliance with policy terms, international standards, and internal procedures.
- Assisted in case management activities in coordination with operational teams to ensure quality of service and timely processing.
- Identified inconsistencies or atypical claim patterns and escalated suspected fraud cases in line with internal controls and guidelines.
Health Board Supervisor / Anesthesiologist-Resuscitator - Health Control Office – Tunis-Carthage Airport - Tunis
(2020-08 - 2021-12)
- Supervised epidemiological surveillance and public health measures at borders.
- Evaluated and processed medical evacuation (air ambulance) patient files, ensuring readiness and safety during transfers.
- Coordinated with international medical teams for urgent evacuations and patient stabilization.
- Intervened in emergency cases, providing intensive care support and first aid when required.
- Led a team of healthcare staff during the COVID-19 project at the airport, ensuring compliance with WHO and international safety guidelines.
- Conducted health data collection, reporting, and decision-making for disease prevention.
التعليم
Master's degree - Public Health Management - ECOLE SUPERIEURE DE COMMERCE TUNIS (2019 - 2021)
Bachelor's Degree - Anesthesia & Intensive Care - UPSAT (2016 - 2019)