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Ronak Abdul, Claims Officer

Ronak Abdul

Claims Officer·Total Care Saudi (TPA)

Saudi Arabia

High school or equivalent, Infection

Work experience

Total years of experience: 9 years, 8 months

Claims Officer

July 2024 - Present

Total Care Saudi (TPA)

Khobar, Saudi Arabia

July 2024 - Present

Tracked key performances indicator related to successful claim resolution and reported finding regulation.
* Reviewed documents such as medical reports, bills, receipts, approvals and contracts to determine eligibility of claims .
* maintained up-to-date knowledge of industry trends, regulations, legislation and best practice related to claims management.
* Performed data entry operations accurately to update records into computerized system .
* Providing guidance to junior collogues on processing complex claims cases. .
* Monitoring changes in policy coverages limits or exclusions which could affect claim settlements .
* Prepared detailed reports outlining process on individual cases for senior management review .
* Identified and collected evidence to determine value to specific claims .
* Reviewed and processed medical bills for policyholders under individual injury coverage .
* Attached information policy to determine coverages .
* Reviewed insurance policy to determine coverage .
* Calculated amount of claim .
* process and recorded new insurance policies and claims .

Company industry:
Insurance & TPA

Sales Team Leader

October 2021 - September 2022

Max Healthcare Institute Limited

Delhi, India

October 2021 - September 2022

* providing guidance and support for junior team members during complex tasks and situation.
* Prepared detailed budget for upcoming projects in order to maximize resources .
* Monitoring customer feedback to improve customer satisfaction rating .
* facilitated weekly meeting with sales team staff to review goals, objects, and progress .
Resolve conflicts between team members through effective communication and problem-solving technique.

Company industry:
Other Healthcare Services

Team Leader

April 2018 - October 2021

Max super specialist hospital

Delhi, India

April 2018 - October 2021

* Working as a senior Nursing staff in neuro ICU Department and 1 year in covid ICU .
* Understand the medico science service .
*Analysis of the all medical condition and diagnosis and give treatment for related diagnosis .
* Helping junior staff during complex situation in the department .
* inventory management .
* Roster management .
* Helping nursing supervisor to give leaves to the junior staff,
* Handling all kind of patient with proper sterilized technique if required .
* Maintained working environment in the department .
* Handling critical ill patient .
* Give assignment according to the experience and knowledge .

Company industry:
Medical Hospital

Senior Nursing Staff

January 2018 - October 2021

Maharaja Agrasen Hospital,

Delhi, India

January 2018 - October 2021

• Managed sterilization protocols, emergency drug administration, and
ventilator settings.
• Supervised and mentored junior nursing staff in emergency procedures.
• Ensured compliance with healthcare and hospital protocols.
• Assisted in inventory and roster management for efficient resource
allocation.

Company industry:
Other Healthcare Services

Senior Nursing officer

June 2016 - February 2018

Maharaja Agresan Hospital

Delhi, India

June 2016 - February 2018

* Working as a senior Nursing staff in neuro ICU Department and 1 year in covid ICU .
* Understand the medico science service .
*Analysis of the all medical condition and diagnosis and give treatment for related diagnosis .
* Helping junior staff during complex situation in the department .
* inventory management .
* Roster management .
* Helping nursing supervisor to give leaves to the junior staff,
* Handling all kind of patient with proper sterilized technique if required .
* Maintained working environment in the department .
* Handling critical ill patient .
* Give assignment according to the experience and knowledge

Company industry:
Other Healthcare Services

Registered Nurse

September 2015 - June 2016

NKS Hospital

Delhi, India

September 2015 - June 2016

* Working as a senior Nursing staff in neuro ICU Department .
* Understand the medico science service .
*Analysis of the all medical condition and diagnosis and give treatment for related diagnosis .
* Helping junior staff during complex situation in the department .
* inventory management .
* Handling all kind of patient with proper sterilized technique if required .
* Maintained working environment in the department .
* Handling critical ill patient .

Company industry:
Residential & Nursing Care Services

Registered Nurse

January 2015 - January 2016

NKS Hospital,

Delhi, India

January 2015 - January 2016

• Delivered high-quality patient care in ICU and general wards.
• Assisted in emergency procedures such as intubation, catheterization, and
ECG monitoring.
• Worked closely with doctors and medical teams to ensure optimal patient
outcomes.

Company industry:
Hospitality & Accomodation

internship nurse

January 2015 - March 2015

SK HOSPITAL

Sikar, India

January 2015 - March 2015

I am working as a traning nursing staff there for helping my senior staff and learn a practical think there .

Company industry:
Other Healthcare Services

Education

Maharaj

January 2017

January 2017

High school or equivalent, Infection

India

Rajasthan Nursing Institute

September 2015

September 2015

Diploma, Diploma in general nursing & midwifery

India

Rajasthan Nursing Council

January 2015

January 2015

Bachelor's degree, Nursing

India

Sant Nirankari boys senior secondary school

May 2011

May 2011

High school or equivalent, Senior Secondary School Examination

India

Sant Nirankari Boys Sen. Sec. School

January 2011

January 2011

High school or equivalent, high school

India

Sant Nirankari boys senior secondary school

April 2009

April 2009

High school or equivalent, secondary school Secondary School Examination

India

Skills

MEDICAL INSURANCE CLAIMS
Intermediate
MEDICAL INSURANCE CLAIMS
Intermediate
NURSING
Intermediate
NURSING
Intermediate
HEALTH ADMINISTRATION
Intermediate
HEALTH ADMINISTRATION
Intermediate
SALES
Intermediate
SALES
Intermediate
MARKETING
Intermediate
MARKETING
Intermediate
CLAIMS PROCESSING
Intermediate
CLAIMS PROCESSING
Intermediate
PROJECT RISK MANAGEMENT
Intermediate
PROJECT RISK MANAGEMENT
Intermediate
REGULATORY COMPLIANCE
Intermediate
REGULATORY COMPLIANCE
Intermediate
LEADERSHIP
Intermediate
LEADERSHIP
Intermediate
COMPLEX PROBLEM SOLVING
Intermediate
COMPLEX PROBLEM SOLVING
Intermediate
CUSTOMER SATISFACTION
Intermediate
CUSTOMER SATISFACTION
Intermediate
DATA ENTRY
Intermediate
DATA ENTRY
Intermediate
HEMATOLOGY
Intermediate
HEMATOLOGY
Intermediate
INFECTION
Intermediate
INFECTION
Intermediate
INFECTION CONTROL
Intermediate
INFECTION CONTROL
Intermediate
INSURANCE POLICIES
Intermediate
INSURANCE POLICIES
Intermediate
LEGISLATION
Intermediate
LEGISLATION
Intermediate
MANAGEMENT
Intermediate
MANAGEMENT
Intermediate
MICROSOFT EXCEL
Intermediate
MICROSOFT EXCEL
Intermediate
COMMUNICATIONS
Intermediate
COMMUNICATIONS
Intermediate

Languages

English
Intermediate
Hindi
Native Speaker

Training and Certifications

Certifications
INSURANCE FOUNDATION CERTIFICATION EXAM