Zabi Bawar
Ashburn,VA
Summary
Experienced professional with a wide range of skills including Claims Analysis, customer service, Data Management, Data Analysis, and Data Processing. Proven ability to detect and investigate fraud claims and non-fraud claims, skilled in collecting, organizing, and analyzing data to find patterns and make informed decisions. Proficient in using data management systems and tools to ensure accuracy, security, and compliance.
Overview
10
10
years of professional experience
Work History
CLAIMS ANALYST/
Prime Therapeutics
02.2024 - Current
- Research, resolve, and document physician or client inquiries and grievances, providing verbal or written results to client, prescriber, provider, and management
- Determine appropriateness for medications and communicates decisions to physicians, physician's office staff, medical management staff, and/or pharmacists
- Research, resolves, and documents prior authorization outcomes in the pharmacy system
- Communicate selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician's office staff, medical management staff, and/or pharmacists
- Escalate requests to Pharmacist when extensive clinical review or denial is required
- Performs other duties as required
- Clinically reviewing coverage determinations for medications via Fax with attention to detail
- Communicating decisions to physicians, physician's office staff, medical management staff, and/or pharmacists.
CLAIMS ANALYST/
TTEC Bank of America
07.2020 - 02.2024
- Making complex decisions based on analytical research and judgment to determine whether to approve or reject fraud claims made by customers
- Gathered evidence, which included recorded and written statements, financial documentation and audio materials for examination
- Conducted preliminary investigations to confirm violations that occurred and obtained relevant documents and testimony from involved parties
- Developing and implementing fraud prevention strategies and controls
- Identified patterns of fraud in clients' financial transactions, including credit and debit card prepaid and ATM transactions, dispute management, and dispute resolution
- Collaborating with internal teams, such as risk management and compliance, to mitigate fraud risks
- Evaluated system alerts for potentially fraudulent activity and assess possible courses of conduct, making a decision to pay or deny the claim
- Analyzed financial statements, bank records and government databases to identify fraud and other instances of financial fraud
- Performed other variety of research, auditing, and resolution activities related to the claims.
DATA MANAGEMENT SPECIALIST/
Adroit Associates
06.2019 - 02.2020
- Produced monthly and weekly reports using advanced Excel spreadsheet functions
- Effectively communicated field observations to the M&E Director, providing supporting evidence through photos and beneficiary quotes
- Played a key role in the development of data collection tools, including questionnaires and group discussion guides
- Assisted in the implementation of baseline and impact assessments, as well as conducting focus groups.
RECORDS MANAGEMENTS SPECIALIST/
Adam Smith International
07.2014 - 02.2019
- Logged project starts milestones and completions
- Developed activity tracking and reporting tools
- Managed documents, including, records, correspondence, and reports
- Identified and rectified data entry errors, ensuring data accuracy and integrity
- Utilized modeled data to derive insights and make informed decisions
- Developed and deployed user-friendly dashboards to effectively present data.
Education
BBA - Business Administration
DUNYA University Of Higher Education
08.2019
Skills
- Data Analysis
- Office Suite
- Proficient in Excel
- Claims Processing
- Payment Processing
- Analytical Thinking
- Attention to Detail
- Financial Statements
- Medical Management
- Writing
- Reporting Tools
- Milestones (Project Management)
- Data Quality
- Dispute Resolution
- Management Systems
- Investigation
- Research
- Microsoft Excel
- Authorization (Computing)
- Data Collection
- Prior Authorization
- Management
- Customer Service
- Risk Management
- Microsoft Office
- Data Management
- Auditing
- Data Entry
Languages
English
Timeline
CLAIMS ANALYST/
Prime Therapeutics
02.2024 - Current
CLAIMS ANALYST/
TTEC Bank of America
07.2020 - 02.2024
DATA MANAGEMENT SPECIALIST/
Adroit Associates
06.2019 - 02.2020
RECORDS MANAGEMENTS SPECIALIST/
Adam Smith International
07.2014 - 02.2019
BBA - Business Administration
DUNYA University Of Higher Education
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