Open to opportunities

Dr Sana Madhani

@drsanamadhani

Message

Senior healthcare consultant and medical case manager specializing in insurance automation and rules engines.

United States

Message

What I'm looking for

I’m looking for a role where I can combine medical case management and insurance operations with business rules/automation to improve accuracy and client outcomes. I want a team that values client-centered communication, process excellence, and measurable operational quality.

I provide streamlined solutions for personal injury law firms and providers to promote and maintain client well-being. In my current role, I manage end-to-end medical case work, starting with intake calls and continuing through ongoing client communication and provider coordination.

I also specialize in insurance benefit workflows, including verification of Cancer patient enrollment, quality checks, and obtaining benefits and prior authorization for chemotherapy infusions. I handle high-volume case processing by contacting payers such as Medicare, Medicaid, and commercial insurers (e.g., BCBS, Cigna, Aetna, Humana, UHC).

Earlier in my career, I led automation and rules-driven healthcare operations at Nextcare–Allianz Global Group, serving as an edits supervisor and focal point for automation. I contributed to service code mapping and validation, maintained pricing lists, and supported regulatory coding updates while helping develop and maintain a Claim Edits Engine.

I bring formulary and claim-experience strengths as well, including formulary management across UAE and national/regional standards, service item–benefit correlations, and troubleshooting for pharmacy-related issues. I’m the kind of leader who keeps processes accurate, improves system efficiency through business rules, and supports teams and clients through complex insurance workflows.

Experience

Work history, roles, and key accomplishments

Current

Medical Case Manager

Current

HealthNsync

Sep 2024 - Present (1 year 10 months)

Conduct initial personal injury case intake via client phone calls and coordinate with law firms, providers, and the case portal. Manage medical portions of cases, provide client updates, schedule and coordinate provider transportation, and support attorneys and paralegals.

Medical Case Management Client Communication Provider coordination Case Portal Updates Scheduling Transportation Coordination Paralegal

Current

Benefit Verification Specialist

Current

Cencora - AmerisourceBergen

Oct 2023 - Present (2 years 9 months)

Verify benefits and prior authorizations for cancer patients by reviewing enrollment forms and performing quality checks. Call Medicare, Medicaid, and private commercial payers and Rx companies to support chemotherapy infusion authorization.

Benefit Verification Prior Authorizations Enrollment Form Review Medicaid Commercial Rx Company Coordination Medicare Cigna Aetna Humana UHC Optum

Automation and Controls Edits Supervisor

Nextcare - Allianz Global Group

Oct 2016 - Oct 2018 (2 years)

Supervised teams across UAE and other regional business units for mapping and validation of service codes. Supported automation through service-item correlations, maintained provider service code/price lists, and oversaw pharmacy regulatory coding updates and drug lists.

Team Supervision Service Code Mapping Service Code Validation Automation Support Service Item Correlation Preferred Drug List Management DHA Projects HAAD DHA Regulatory Updates

Medical and Control Edits Officer

Nextcare - Allianz Global Group

Sep 2015 - Oct 2016 (1 year 1 month)

Managed pharmacy formulary lists and performed cross-mapping of new drugs across national and regional pharmacy standards. Developed and maintained a claim edits engine by creating medical rules for system efficiency and supported edits projects (maternity, dental, optical).

Formulary Management Drug Inclusion Coordination Least Unit Per Drug Identification Cross Mapping Pharmacy Standards Mapping (DHA)Oman Qatar Bahrain Kuwait Service Benefit Correlations Coding Specialist Support (Pharmacy)Rules Claim Edits Engine Development Drug Frequency Module Medical Edits Projects (Maternity)Dental Optics

Claims Adjudicator

Nextcare - Allianz Global Group

Dec 2013 - Aug 2015 (1 year 8 months)

Verified patient information and arranged insurance approvals for medicines, vaccinations, and various authorizations across medical and dental categories. Followed up with providers and payers, handled reimbursement issues, resolved Pulse-related technical issues, and supported pharmaceutical benefit management using internal systems.

Pulse Issue Resolution TATSH Web FMS ITS

Pharmacy Intern

Al Kindi Group of Pharmacies

Feb 2012 - Feb 2014 (2 years)

Provided customer service in person and by phone, counseled patients, and assisted with dispensing medications. Monitored drug selection and usage (including side effects) and obtained insurance approvals before dispensing.

Patient Counseling Exercise Stress Management Home Medical Equipment Pharmacy Prior Authorization Customer Service