AKWEI BULLEY THOMAS
Accra
Summary
Highly experienced Health Insurance & Claims Management Professional with over 12 years’ experience across private health insurance, and corporate managed care environments. Demonstrated expertise in medical claims vetting, utilization review, fraud detection, provider audits, cost containment, and regulatory compliance. Proven ability to generate significant claims savings, strengthen internal controls, and improve provider accountability. Strong leadership, analytical, and reporting skills with deep healthcare system knowledge.
Overview
14
14
years of professional experience
1
1
Certification
Work History
General Manager / Shareholder
Vision Touch Solutions (VTS)
Accra
06.2023 - Current
- Provide executive oversight for operations, contracts, and compliance
- Negotiate service contracts and manage financial accountability
- Supervise field teams and ensure adherence to safety and quality standards
- Represent organization in high-level stakeholder engagements
Senior Claims Officer
GAB Health Insurance Company Ltd
Accra
09.2022 - 05.2023
- Vet and adjudicate medical claims in line with policy guidelines and benefit schedules
- Identify, investigate, and block fraudulent, inflated, and non-compliant claims
- Conduct on-site provider audits and claim verifications at HSPs
- Perform pre-authorizations for medical procedures, optical, and dental services
- Prepare claims trend, utilization, and cost analysis reports for management
- Reconcile, sign off, and approve duly verified claims for payment
- Collaborate with Client Relations and Provider Management teams to resolve disputes
- Support claims quality improvement and internal control systems
Operations Supervisor
Supreme Healthcare Management Services (EAP-Africa)
03.2021 - 08.2022
- Supervised healthcare operations supporting corporate and insured clients
- Coordinated consultants and service providers based on client needs
- Developed operational strategies to improve service efficiency and quality
- Prepared structured monthly operational and performance reports
Claims Manager / Head of Claims (EXCOM Member)
Apex Health Insurance Ghana Ltd
01.2020 - 02.2021
- Headed the Claims Department with full responsibility for claims governance
- Led claims vetting, adjudication, utilization review, and fraud management
- Served as Executive Committee Member, contributing to strategic decisions
- Conducted provider audits, investigations, and utilization reviews
- Prepared and presented monthly, quarterly, mid-year, and annual claims reports
- Delivered claims cost, trend, and utilization analysis to Operations and Finance
- Issued adjudication and utilization reports to corporate clients
- Strengthened claims controls resulting in improved cost containment
Nursing Officer / Ward In-Charge
Christos Holistic Medical Center
11.2018 - 01.2021
- Managed ward operations, staffing, and clinical compliance
- Ensured adherence to standard treatment protocols and patient safety
- Coordinated physicians and supervised nursing teams
Nursing Officer / Deputy Ward In-Charge
Ankaful Psychiatric Hospital
12.2011 - 08.2017
- Conducted mental health assessments and admissions
- Prepared daily clinical and administrative reports
- Supervised staff and coordinated psychotherapy and occupational therapy
Education
BSc. - Mental Health Nursing
University of Cape Coast
01.2016
Diploma in Mental Health Nursing -
Ankaful Nurses Training College
01.2009
WASSCE -
Berekum Senior High School
01.2005
Skills
- NHIA Standards & Private Health Insurance Operations
- Medical Claims Vetting & Adjudication
- Fraud Detection
- Abuse & Cost Containment
- Provider (HSP) Audit & Credentialing Support
- Utilization Review & Pre-Authorization
- Claims Trend & Utilization Analysis
- Policy Interpretation & Compliance
- Risk Management & Internal Controls
- Stakeholder & Provider Relationship Management
- Claims Reporting (Monthly, Quarterly & Annual)
- Team Leadership & Capacity Building
- MS Excel
- MS Word
- RX Health Software
Certification
- Certificate in Client Relationship Management – Quartsons Business Solutions
- 12-Step Drug & Alcohol Rehabilitation Training (USA Foundation)
- Certificate in Ministry – School of the Word
- Training in Epoxy & Terrazzo Floor Management
References
Available upon request (Can be provided separately if required)
Additional Value To Insurers
- Proven claims savings through strict vetting and fraud prevention
- Strong understanding of provider billing behavior and utilization risks
- Excellent reporting skills aligned with NHIA, Private, and Corporate Insurer Standards
- Suitable for roles such as: Claims Manager / Head of Claims, Claims Auditor, Utilization Review Officer, Health Insurance Operations Manager, Provider Audit & Compliance Officer
Leadership And Professional Affiliations
- Western/Central Regional Secretary – Nurses Christian Fellowship Ghana
- National Campus Coordinator – Capstone Outreach International
- Public Relations Officer – Passion for Sound Mind Ghana (Health NGO)
- Organizing Team Member – Touch Group Foundation (Community NGO)
Timeline
General Manager / Shareholder
Vision Touch Solutions (VTS)
06.2023 - Current
Senior Claims Officer
GAB Health Insurance Company Ltd
09.2022 - 05.2023
Operations Supervisor
Supreme Healthcare Management Services (EAP-Africa)
03.2021 - 08.2022
Claims Manager / Head of Claims (EXCOM Member)
Apex Health Insurance Ghana Ltd
01.2020 - 02.2021
Nursing Officer / Ward In-Charge
Christos Holistic Medical Center
11.2018 - 01.2021
Nursing Officer / Deputy Ward In-Charge
Ankaful Psychiatric Hospital
12.2011 - 08.2017
BSc. - Mental Health Nursing
University of Cape Coast
Diploma in Mental Health Nursing -
Ankaful Nurses Training College
WASSCE -
Berekum Senior High School