Manager - Medical Claims and Enrollment Operations
MSH International
Total years of experience :11 years, 1 Months
DESIGNATION CHRONOLOGY:
• Nov 2009 - Feb 2016: Manager - Medical Claims and Enrollment Operations
• Mar 2007 - June 2007: Claims and Customer Care Administrator
HIGHLIGHTS:
• Implemented employee skill development and motivation exercise, leading to a 15% reduction in staff turnovers, which set a benchmark for the upcoming years.
• Recognized by the management for showing determination and achieving ZERO unresolved customer complaints over a 3-year span.
• Successful in increasing the business retention rate from 80% to 90% by establishing contact with maximum number of existing clients.
• Instrumental in the achievement of ISO 9001 - 2008 Certification for the company, through the implementation of ISO standard processes.
• Spearheaded KAM activities for Schlumberger Oil Service (over 25000 lives), L’Oreal, MSF, Channel, Michelin etc, and functioned as the central contact point for their HR Managers.
• Conceptualized and deployed an online enrolment tool in the local market, eventually leading to a decrease of 30% in the turnaround time for enrollment and card printing.
• Achieved a 6 percent increase in the Customer Satisfaction Index for the Dubai branch, from 86% to 92%, through effective dispute resolution, claims processing and overall operations management.
KEY RESPONSIBILITIES AS MEDICAL CLAIMS MANAGER:
DEPARTMENTAL PLANNING:
• Handled charge for cross-functional team of 18 personnel comprising of claims administrators and customer service executives.
• Reported to the Operations Manager, streamlined departmental processes, assigned daily tasks to the team and followed-up for completion.
• Scheduled and chaired day-to-day operational planning meetings with the team, discussed pressing issues and provided solutions to overcome challenges.
• Monitored the flow of information within team members, and focused on controlling the claims process to achieve operational excellence.
CLAIMS PROCESSING MANAGEMENT:
• Conducted thorough analysis of claims, determined cases of overpayments, underpayments, and reported loss ratio to the senior management.
• Verified healthcare claim accuracy as per the company’s norms, and validated / rejected the processing exercise accordingly.
• Collaborated with the financial accounting team for the release of payments for accepted healthcare claims, and ensured that the amounts are deposited in respective accounts within the pre-defined timeframe.
• Ensured effective coordination within the department to process medical claims, reimburse amounts, and maintain records.
CUSTOMER SERVICE OPERATIONS:
• Promoted optimum service levels within the operation, and ensured that direct billing cards are printed and dispatched to clients.
• Managed customer escalations, followed-up with team for complaint related tasks, and ensured that clients receive timely resolution.
• Initiated and implemented process improvement programs to standardize SOPs, develop system tools, and enhance performance.
• Organized and delivered trainings to various team members to build their competence, and develop overall organizational talent.
Continued from previous section....
ADMINISTRATION:
• Maintained the customer database, updated records on receipt of intimation from customers regarding change in personal information, bank details and nominee information.
• On completion of registration formalities, oversaw the distribution of direct billing cards and welcome packages within the allotted lead time.
• Coordinated with the finance team to prepare and finalize monthly reconciliation statements and addition / deletion reports and created separate files for records and reference.
• Officially communicated with various internal and external entities including sales teams, operations unit and clients to ensure processing efficiency and completion of administrative tasks.
• Led the policy renewal process, scrutinized documents submitted by clients, collected premium amounts and directed the sales teams to complete renewals in time.
• Defined and recorded long-term and short-term financial benefits for each client in line with the terms & conditions of particular policies and insurance schemes; entered details of new / prospective clients and endorsements.
HEALTHCARE NETWORK MANAGEMENT:
• Maintained the medical network in the region as a representative of the insurance service provider, enabled network benchmarking and expanded market reach.
• Administered provider contracts, and reviewed and finalized tariff revisions considering the changing technology and treatment methods in the healthcare sector.
• Investigated cases / claims through medical provider surveys, carefully studied results, finalized the action plan and forwarded recommendations to the operations team.
KEY RESPONSIBILITIES AS MEDICAL CLAIMS ADMINISTRATOR:
• Handled end-to-end processing of medical claims, including reimbursement of claim amounts, direct billing, and record-keeping.
• Attended to queries / inquiries from customers, provided them with necessary information regarding their claim status as per the database.
• Reported to the Claims Manager, and ensured exceptional customer service operations by handling client interactions and complaints.
• Involved in the calculation of amount of medical expenses, which was then considered for the settlement of given portfolios.
• Maintained cordial relations with policyholders and all customers, with focus on increasing the company’s business through repeat / referral opportunities.
• Coordinated with other departments including accounting and enrolment, for completing processing of claims.
My thesis was "Care of Asthmatic Patients in Paediatrics"
