Raghda Sayed

Senior Medical Claims auditor and Data Analyst with a strong clinical background as a Pharmacist. Over 4 years of extensive experience in healthcare insurance operations, medical claims processing, utilization review, auditing, and quality assurance (QA). Expert in utilizing advanced business intelligence (BI) tools including Power BI, SQL, and Python to create interactive dashboards.

Ensured HIPAA-compliant claims processing by implementing privacy and security protocols. Experienced with CCHI regulations, NPHIES workflows, and Saudi health insurance standards.

Senior Claims Officer at MedNet Global Healthcare Solutions (Third Party Administrator for MetLife UAE) (2025-04 – Present)

• Process, review, and adjudicate over 200 medical insurance claims daily while ensuring accuracy, policy compliance, and risk assessment.
• Audited processed claims, maintaining corporate quality standards and reducing processing errors to achieve a 99.8% quality rate.
• Delivered technical training to more than 25 new hires, boosting team performance by 15% via targeted coaching and workflow optimization.
• Analyze complex provider denial reports and build interactive dashboards to monitor medical provider trends, team KPIs, and quality metrics.
• Collaborate closely with the Quality Assurance (QA) team to analyze monthly audit reports and implement strategic process improvements.

Claims Officer at MedNet Global Healthcare Solutions (Third Party Administrator for MetLife UAE) (2023-09 – 2025-04)

• Process, review, and adjudicate over 200 medical insurance claims daily while ensuring accuracy, policy compliance, and risk assessment.
• Audited processed claims, maintaining corporate quality standards and reducing processing errors to achieve a 99.8% quality rate.
• Delivered technical training to more than 25 new hires, boosting team performance by 15% via targeted coaching and workflow optimization.
• Analyze complex provider denial reports and build interactive dashboards to monitor medical provider trends, team KPIs, and quality metrics.
• Collaborate closely with the Quality Assurance (QA) team to analyze monthly audit reports and implement strategic process improvements.

Medical Coordinator & Approvals Doctor (Customer Service Department) at MedRight for Medical Services (2023-05 – 2023-09)

• Coordinated over 40 medical approvals daily and managed direct inquiries from healthcare providers and clients regarding policy boundaries.

Pharmacist at Merqah Charitable Foundation (2022-09 – 2023-05)

• Oversaw daily pharmacy operations, reviewed, verified, and approved specialized medication requests according to established clinical guidelines and healthcare standards.

Bachelor of Pharmacy in Pharmacy – Cairo University (2017-09 – 2022-07)