George willington sathias nesan

Qatar Insurance Company, Dubai, UAE.
Medical Officer (February 2010 - till date)

Maintaining detailed knowledge of new and existing products by liaising with colleagues;
Developing and maintaining good working relationships with clients, primarily Insurance
Brokers.

➢ Planning of daily work schedule of the claims processing in my department.
➢ Reporting to the Manager regarding the claims statistics (TAT) of Network claims and for reimbursement claims.
➢ Administration and correspondences regards to claims with TPA's, insured groups, brokers and individuals.
➢ Approving in-patient medical cases with help of Third party administrators.
➢ Advising and answering queries from different participating companies and individuals.
➢ Handling reconciliation of claims on daily basis.
➢ Claims analysis of groups on quarterly basis and forwarding the same to the client.
➢ Providing the Manager with the loss ratio of the group in coordination with the underwriting department in order to facilitate the renewal terms submission.
➢ Answering queries about the policies to both clients and brokers.
➢ Well versed knowledge about HAAD regulations and implementations.
➢ Attending regular meetings with the direct clients and TPA's in order to maintain the proper service level agreements (SLA)
➢ Attending meetings with HAAD along with TPA in case of any discrepancies in the claim settlement or approvals/denials

Maintaining detailed knowledge of new and existing products by liaising with colleagues;
Developing and maintaining good working relationships with clients, primarily Insurance
Brokers.

 Planning of daily work schedule of the claims processing in my department.
 Reporting to the Manager regarding the claims statistics (TAT) of Network claims and for reimbursement claims.
 Administration and correspondences regards to claims with TPA’s, insured groups, brokers and individuals.
 Approving in-patient medical cases with help of Third party administrators.
 Advising and answering queries from different participating companies and individuals.
 Handling reconciliation of claims on daily basis.
 Claims analysis of groups on quarterly basis and forwarding the same to the client.
 Providing the Manager with the loss ratio of the group in coordination with the underwriting department in order to facilitate the renewal terms submission.
 Answering queries about the policies to both clients and brokers.
 Well versed knowledge about HAAD regulations and implementations.
 Attending regular meetings with the direct clients and TPA’s in order to maintain the proper service level agreements (SLA)
 Attending meetings with HAAD along with TPA in case of any discrepancies in the claim settlement or approvals/denials

 Properly guiding the clients regarding the health instruction in order to reduce the weight and maintain a proper healthy diet.
 Attaining the business targets on monthly basis.

VLCC, Dubai, UAE.
Medical Instructor (2008-2010)
➢ Properly guiding the clients regarding the health instruction in order to reduce the weight and maintain a proper healthy diet.
➢ Attaining the business targets on monthly basis.

 Forwarding documents to various TPA’s for prior approval of various cases.
 Regular follow-ups will be done with the TPA’s to get the approvals on time which will enable the satisfaction of the client.
 Reporting to the management regarding the work flow of the department on weekly basis.
 Efficient in leading a team of members in order to facilitate the proper work flow in the department.

Dr.Joseph's Polyclinic, Dubai, UAE.
Insurance Co-ordinator (2006-2008)
➢ Forwarding documents to various TPA's for prior approval of various cases.
➢ Regular follow-ups will be done with the TPA's to get the approvals on time which will enable the satisfaction of the client.
➢ Reporting to the management regarding the work flow of the department on weekly basis.
➢ Efficient in leading a team of members in order to facilitate the proper work flow in the department.