Nayera Samy

Led the chronic medications approvals team, supervising 10 approval officers while ensuring compliance with insurance policies and SLA requirements. Oversaw daily workflow, improved approval turnaround time, and reviewed lab tests, radiology reports, and claim forms for outpatient chronic medication requests.

Reviewed and approved chronic medication requests in line with policy guidelines and medical necessity. Coordinated with healthcare providers for long-term treatment plans, ensured policy compliance, and monitored chronic cases to support cost-effectiveness.

Reviewed and analyzed medical claims, invoices, and supporting documentation for accuracy. Detected unusual patterns and investigated suspicious client, provider, or member activity while staying aligned with evolving healthcare regulations.

Checked the validity of claims and obtained insurance company approval to dispense medications. Escalated issues to the insurance company by email when medication or claim validity had problems.

Processed medical applications from the sales channel and completed client data handling. Issued and managed medical policies and cards, performed renewal processing based on renewal batch consumption, and prepared medical referral reports for additional exclusions.

Provided patient counseling and managed the delivery, stocking, and labeling of products. Monitored product condition to help prevent expiration or deterioration.

Provided community pharmacy support and managed product delivery, stocking, and labeling. Monitored product condition to help prevent expiring or deterioration.

Earned a B.Sc. in Pharmacy at Cairo University (credit hours system), with a major in clinical system, completed between 2016 and 2021.