Riyadh, Saudi Arabia
معاذ الحربي
Health operations leader working on DRG implementation, medical cost governance, and provider network strategy across the Saudi insurance ecosystem.
DRG-coded claims — national adoption scaled from zero, with 5+ providers onboarded and two onsite alignment workshops driving company-wide rollout.
Inflation exposure surfaced across provider groups through a cost-inflation dashboard now used in executive cost-governance decisions.
Provider tier changes enabled by internal and external CPM benchmarks built across 13 KSA regions, feeding a major network refresh.
Processing time on a manual distribution workflow — from more than two hours a day to ten minutes through automation.
Approval delays removed by re-engineering transfer-approval coordination and urgent-case escalation.
Executive dashboards delivered across DRG, inflation, contracting, reconciliation, and claims — the reporting layer behind day-to-day operational decisions.
I have spent seven years inside the KSA health insurance ecosystem, most of it on the operational side of the payer: claims, coding, provider contracts, and the data that governs medical cost. My work sits where clinical reality meets financial consequence — translating what happens in a hospital into something an executive committee can price, benchmark, and decide on.
My background is clinical — a physical therapy degree from King Saud University — which is why DRG work made sense to me early. Understanding a case mix is not a spreadsheet exercise; it is reading documentation the way a coder and a clinician both read it. That grounding, combined with financial analytics and formal negotiation training, is still an uncommon combination in this market.
Today I lead operational-excellence programs at Tawuniya, running a team of twelve across DRG readiness, reconciliation, data governance, and workflow automation, and I am completing an Executive MBA in corporate finance and strategic operations.
01 — Coding & case mix
AR-DRG grouper methodology, ICD-10-AM / ACHI / ACS coding quality, clinical documentation improvement, and provider onboarding — from first coded claim to steady-state volume.
02 — Cost & governance
Cost-inflation analytics, CPM benchmarking, claims and rejection management, medical audit, and the KPI frameworks that make cost drivers visible before they land on a renewal.
03 — Network & contracts
Tiering and network optimization across regions, contract and pricing strategy, negotiation, and the performance scorecards that hold both sides of a provider relationship to the same numbers.
Aug 2023 — Present
Tawuniya Insurance Company · Riyadh
Mar 2023 — Aug 2023
Tawuniya Insurance Company · Riyadh
Jan 2022 — Mar 2023
Tawuniya Insurance Company · Riyadh
Nov 2020 — Dec 2021
Al Rajhi Takaful · Riyadh
Nov 2019 — Nov 2020
Al Rajhi Takaful · Riyadh
Earlier — Health Claim Processor, Al Rajhi Takaful (May 2019 — Nov 2019).
2027
Executive MBA, King Saud University Expected Jun 2027 · Corporate finance, strategic operations, managerial accounting
2023
The Professional Negotiator The Gap Partnership
2023
Clinical Documentation Specialist Training
2022
Insurance Foundations, professional exam (3rd edition) The Financial Academy
2021
Diploma, Hospital & Health Institutions Management Abha Chamber
2017
Bachelor of Physical Therapy, King Saud University