Team Leader Operations
Wapmed TPA Service Co FZ LLC
مجموع سنوات الخبرة :10 years, 11 أشهر
Currently Working as Operations Team Leader - Claims Administrator in Wapmed TPA Service Co in collaboration with Warba Insurance Company, Apollo Group and FHPL.
Overview: Overall Responsibilities of handling claims team and regular update of norms of local bodies (Health Authority of Abu Dhabi- HAAD and Dubai Health Authority- DHA).
1. Successfully implemented e-claims project - designing & operations of e-claims Process flow.
2. Coordination with HAAD and DHA and third party applications support.
3. Closely working with insurance bodies
• Projections & Fund Management - Monthly projections forecasting and managing funds accordingly.
• MIS - Payouts, Loss ratios, Standard reports.
• Payments follow up.
4. Interaction with Hospitals for reconciliation and payment updates.
5. Claims Management: With the strong, motivated & Productive team which give results of successful implementation of eclaim project.
• Overall monitoring Operations
• Team productivity
• Claims TAT, maintaining FIFO, Inward Vs Outward
• Call center - No. Calls received Vs Bounced back, Services quality & Feedback.
• Coordination with Application support team for Application bugs and development of application support.
• Monthly and Weekly analytical report - Inward, Payouts, Rejections and suspended claims.
4. Provider relations: reconciliation of statement on monthly basis, coordination general queries (Invoices mismatch/ mismatch in medical documents ect.), Sign off letter on quarterly basis & Final Documentations & Claims Submission report to HAAD.
5. Successfully implemented e-claims & PBM project - designing & operations of e-claims Process flow.
6. Office Operations and Administrative Activities
7. Project on Creative Internal Query Management to reduce the interaction between the departments which help to reduce the flow of mails, time, maintain transparency between the departments & Quick decision making support.
Worked in ICICI Lombard Health Care (ICICI Lombard General Insurance Company) as a Customer Service Manager Under Group Health Insurance Team and then promoted in Personal Accident and Secure mind claims Management Team.
Award: Star Performance award for year 2012.
Group Health Insurance:
• Handling a Product of Group Health Insurance - GHI
• Overall Responsibility of managing the Team for Assessment of the claims.
• Allocating Targets to the Team members.
• Handling Team issues and evaluating them as indoor and outdoor.
• Indoor: Cashless Team issue and Internal issues (coordinating with internal Teams).
• Outdoor: Provider management Team who interact with Hospital. Issues will be provided to them to solve.
• Control the stock and evaluating the Pendency weekly twice.
• Claim to be process on FIFO bases.
• Tracking system of the claim.
• Daily MIS will be providing to Respective Supervisor.
Promoted to
Personal Accident, Card Products and loan Products.
• Technical Quality Check of the claim Documents (Policy Conditions/Policy wordings Supportive Documents and Deviations)
• Coordinating with Marketing Officers and Under Writers.
• Decisions Taking Step for approving / rejecting the claim for Reprocessing.
• In-depth study of the case with the help of investing team.
• Working under pressure and escalations the team will take Decision at our end will send a Approval to Management Supervisors based on claim amount.
• Requesting to the Accounts Team for the payment of claim after taking necessary approvals.
• Coordination with IT team for up gradation of application for error free process.
Employee Development in organization
Diksha Learning Center Organized by Central HR team:
Continuous Learning Program: Regular Exam will be conducted by Internal HR team and update the product Knowledge. Training and Development: Certificate of Effective Personal/ Soft Skills.
Other Activities: Frontier in participating and handling the Operations of Events.
OVER ALL RESPONSIBILITY OF HOSPITAL.
DIPLOMA IN HOSPITAL MANAGEMENT APPROVED BY AICTE. INTERNSHIP DONE IN APOLLO HOSPITAL AND DISSERTATIONS DONE IN SAME.