Universal Health Insurance
Contributed to Egypt's national Universal Health Insurance project — integrating digital solutions and shaping insurance strategy inside a telecom-driven healthcare model.
Mohamed
Tayseer
I turn healthcare insurance operations into configurable, measurable systems — connecting claims, provider networks, production workflows, and business rules to decision-ready analytics.
11+years across healthcare & insurance
10roles — pharmacist to head of department
02flagship system implementations
MBANexford University, 2024
01
Profile
Operational depth,
a systems mind.
Mohamed brings pharmaceutical science foundations into healthcare insurance operations — with hands-on experience across claims, medical networks, production, policy setup, system configuration, and digital healthcare implementations.
His work sits where business rules meet technology: eliciting requirements, shaping benefit structures, configuring medical insurance products, validating releases, coordinating stakeholders, and building analytical visibility into cost, utilization, provider performance, and loss ratio.
02
Flagship work
Where the CV turns into impact.
Insurance system implementation & migration
Led implementation of a new end-to-end insurance system: business requirements mapping, process and workflow design, stakeholder alignment, vendor coordination, UAT, and post-go-live support.
Configuration governance
Policy benefits, business rules, pricing logic, provider networks, claims rules, and endorsements — translated into controlled system specifications and BRDs.
Decision-ready analytics
Dashboards for claims cost, utilization, loss ratio, and provider performance — surfacing cost-reduction opportunities and supporting strategic decisions.
Network & claims leadership
Provider network expansion, contract negotiation, fraud detection measures, and claims accuracy across hub operations.
03
Experience
Eleven years, one ladder.
Every step of the progression — from hospital pharmacy to claims, provider networks, system configuration, and department leadership.
-
Apr 2025 — Present
Head of Production, System Configuration & Data Analysis
Limitless Care · Cairo
Owns the end-to-end policy onboarding and change lifecycle: business analysis, benefit configuration, BRDs, cross-functional workshops, UAT, analytical dashboards, and the production & card-issuance function.
-
Nov 2024 — Apr 2025
Medical Network Manager
MedRight for Medical Services · Cairo
Expanded the provider network, developed new provider partnerships, led the network operations team, and implemented data-driven reporting and fraud detection measures.
-
Jan 2024 — Oct 2024
System Configuration & Production Manager
Limitless Care · Cairo
Managed configuration for policies, benefits, pricing, networks, and claims rules; translated requirements into BRDs; drove workflow digitization, testing cycles, and vendor collaboration.
-
Jun 2021 — Dec 2023
Configurations & Claims Hubs Assistant Manager
Limitless Care · Cairo
Managed system and production configurations for medical insurance processes and oversaw claims hubs for timely, accurate processing.
-
Apr 2020 — Dec 2021 concurrent
Senior Insurance Specialist
Vodafone Egypt · Cairo
Contributed to the Universal Health Insurance project and developed insurance strategies within a telecom-driven healthcare model.
-
Jul 2019 — Mar 2020
Senior Medical Network Officer
MedNet Egypt · Cairo
Expanded and managed the provider network, negotiated contracts, and ran data-driven analysis for network optimization.
-
Mar 2017 — Jul 2017 concurrent
Medical Representative
Apex — Multi Apex Pharma · Cairo
Promoted pharmaceutical products to healthcare professionals with scientific, ethics-first communication.
-
Oct 2016 — Jun 2019
Medical Network Officer
MedNet Egypt · Cairo
Built provider relationships, negotiated contracts, ensured regulatory compliance, and audited service quality.
-
Dec 2015 — Oct 2016
Claims Officer
MedNet Egypt · Cairo
Reviewed and processed medical claims, investigated complex cases, and implemented quality assurance measures.
-
Dec 2014 — Jun 2016 concurrent
Pharmacist
International Medical Center · Cairo
Managed hospital ward pharmacy operations, medication dispensing, consumables inventory, and patient counseling.
04
Capabilities
The working toolkit.
- Healthcare insurance operations
- Claims processing, production, card issuance, endorsements, policy updates, SLA adherence, quality controls, fraud-risk awareness.
- System configuration
- Business rules, benefit structures, pricing, provider networks, claims rules, configuration specifications, release validation.
- Business analysis
- Requirement elicitation, BRDs, stakeholder workshops, impact assessment, change prioritization, process mapping, UAT scenarios.
- Provider network management
- Provider relations, contract negotiation, regulatory compliance, network expansion, provider performance analysis.
- AI & data analytics
- AI-assisted analysis, Excel, Power BI — claims cost, utilization patterns, loss ratio, dashboards, executive insight.
- Leadership & communication
- Team direction, cross-functional alignment, vendor coordination, negotiation, operational change, strategic execution.
05
Education & certifications
Master of Business Administration
Nexford University, Washington D.C. — Dec 2024
BSc, Pharmaceutical Science
Cairo University, Faculty of Pharmacy — 2008–2013
- Marketing StrategyNexford · Mar 2024
- Leadership & Organizational DevelopmentNexford · Feb 2024
- Change Management FoundationsLinkedIn Learning · Jan 2024
- Leading ChangeLinkedIn Learning · Jan 2024
- Global BusinessNexford · Dec 2023
- Advanced Business FoundationsNexford · Aug 2023
- Being an Effective Team MemberLinkedIn Learning · Jul 2023
- Lean Six Sigma WorkshopBlack Belts Egypt · Aug 2018
06
Contact
Let's talk healthcare systems.
Open to healthcare insurance, digital health, and operational transformation conversations.