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Irfankhan Golandaj

@irfankhangolandaj

Senior Medical Claims Officer at Takaful Emarat PSC, adjudicating health insurance claims and investigating doubtful claims.

United Arab Emirates

Message

At Takaful Emarat PSC, I reviewed and adjudicated medical insurance claims, checking policy terms, medical necessity, and supporting documents before making approval, denial, or information-request decisions. I also investigated doubtful claims and coordinated with finance and TPAs to support timely settlements.

Previously, at Union Insurance Company, I assessed reimbursement claims and supported fraud prevention. At Aafiya TPA, I reconciled claims and investigated disputed balances; at Wapmed TPA, I adjudicated direct billing and reimbursement claims and reviewed medical records for medical necessity and policy compliance.

Experience

Work history, roles, and key accomplishments

Senior Medical Claims Officer

Takaful Emarat PSC

Jul 2023 - Aug 2026 (3 years 1 month)

Reviewed and processed medical insurance claims, ensuring compliance with policy terms and regulatory guidelines. Adjudicated claims, investigated doubtful cases, and coordinated with finance and TPAs for timely settlement.

Medical Claims Review Adjudication Claims Verification Fraud Detection Medical Records ICD 10 CPT Coding Customer Service Provider communication TAT Management Compliance Microsoft Office

Senior Officer Health Claims

Union Insurance Company

May 2021 - Jul 2023 (2 years 2 months)

Assessed reimbursement claims for policy eligibility and medical necessity, identified suspicious claims, and supported fraud prevention. Maintained claims records, monitored turnaround times, and coordinated with TPAs to improve service quality.

Claims Assessment Fraud Detection Medical Necessity Review TPA Coordination Turnaround Time Management Customer Service Documentation

Senior Executive Claims Reconciliation

Aafiya TPA

Jun 2017 - Mar 2021 (3 years 9 months)

Executed detailed medical claims reconciliations to resolve discrepancies, overpayments, and uncollected balances. Investigated disputed claims and prepared financial summaries to streamline invoice settlements.

Claims Reconciliation Discrepancy resolution Financial Analysis Provider Relations Invoice Reconciliation And Accuracy Standards

Medical Claims Officer

Wapmed TPA

Mar 2016 - May 2017 (1 year 2 months)

Adjudicated direct billing and reimbursement claims according to policy terms and conditions. Reviewed medical records to determine medical necessity and ensured accurate processing within TAT and regulatory guidelines.

Claims Adjudication Direct Billing Reimbursement Medical Records Review TAT Compliance Provider Liaison