Assistant Vice President- Health Insurance Operations
British American Insurance Co. Ltd
Total des années d'expérience :12 years, 2 Mois
Assistant Vice-President: Health Insurance Operations- May 2013-Till Date
British American Insurance Co. Ltd
The position involves day to day management of Health Insurance business operations, health risk management, planning & implementation & customer service
Key tasks involves: • Membership management- issuance of policies, invoices & endorsements
• Claims management
• Resolving customer issues
• Overseeing In-Patient & Out-Patient authorizations & approval of high cost authorizations
• People management- mentoring & coaching
• Dispute resolution
• Close monitoring of SLAs
• Liaising with companies/clients & providers
• Strategic planning & implementation of management vision
• Support to sales
• Improvement in business processes
• New business & renewal underwriting
• Projects
Head: Risk Management & Projects - Jan 2012 - May 2013
Momentum Health (Mauritius) Limited \[Subsidary of MMI Holdings\]
The position involves overseeing the operations of key departments, risk management, quality assurance, provider relations, training,
decentralization & improving customer experience
Key tasks involves: • Enterprise risk management
• Health risk portfolio management
• Health risk underwriting
• Operational risk management & Business continuity planning
• Provider network & franchise risk management including vendor selection
• Clinical & claim data analysis & product designing
• Trouble exposure planning
• Designing of health risk management strategies covering disease management & preventive programs
• Problem solving in various departments like Membership, Claims, HRM, CS & Accounts
• Designing & improving processes in all departments including new reports & access rights management
• Projects identification
• Execution of projects as per project schedule
• Legal & operational compliance
• Designing the quality manual
• International product decentralization & administration
• Business intelligence, product development & competitor analysis
• Member & chairman of various management committees
Head: Health Risk Management & Claims - May 2011 - Dec 2011
Momentum Health (Mauritius) Limited \[Subsidary of MMI Holdings\]
The position involves leading departments like: • Health Risk Management
• Claims Management
• Underwriting-Medical
• Provider Relations
Health Risk Manager- Mar 2010 - Apr 2011
Momentum Health (Mauritius) Limited
The position involves ownership of total authorization process, underwriting, claims management, supplier management, disease
management, B2B interactions, project management, product development & research
Achievements & contributions: • Setting up of Health Risk Management department & identifying the key employees for the department
• Revamping of Pre-Authorization process for both In-Patient Admissions & Out-Patient services
• Introduced scale of cost & out of network authorizations
• Introduced process for sending clients abroad for treatments & streamlined business decisions for such • Setting up of a supplier network of clinics, pharmacies, opticians & dentists on cost based agreements
• Defining the underwriting policies according to the Momentum Africa Underwriting framework
• Risk assessment on case to case basis & indicated loading of premiums
• Introduced NICE guidelines & international protocols in relation to health risk management
• Setting up of a new process of supplier claims assessment separating it from the member operations, made provision of reconciliation with suppliers on terms of payments
• Bringing disease management of chronic diseases in-house
• Stream lining of different processes in various departments
• Designing new products & changing the existing products to continuing attracting new customers & satisfying the present
ones
• Introduced ICD 10, CPT4, HCPCS coding in Momentum Mauritius
• Initiated the Designated Service Provider model in Mauritius & made 3 contracts with key clinics in Mauritius
• Designed service level agreements with providers
• Working on the new life & international products due for launch in 2011
• Well respected by all the clinics in Mauritius as the key person to approach in terms of problem resolving
• Good relations with CEO's, CFO's, HR's, brokers & agents of many key corporates of Mauritius
Project Coordinator- Jan 2008 - Feb 2010
Chitkara Global Education Limited, Mauritius
The position include fesability study, project planning & implementation, interaction with different stakeholders
including government & university, course content development, logistic support
Achievements & Contributions: ● Done fesability study for a medical school project
● Made planning to set up a medical school from scratch
● Liased with MOH, UTM & TEC regarding approval of program
● Made leads in different departments for the movement of project
● Provided technical support in development of M.B.B.S. Program
● Working on infrastructure development & set up of laboratories
● Working on technical loopholes in the clinical attachment at one of government hospital
Clinical Practice & Healthcare Management Executive- Jan 2003 - May 2007
Milestone & Co. Ltd, Delhi
The position include patient interaction, management & administration, B2B operations, Business development, Market analysis,
product development, people management
Achievements & Contributions: • Clinical practice operations
• Interaction with healthcare business community including doctors, medical labs & pharmaceutical companies
• Revamped working process, introduced best practices, managed changes & managed people
• Prepared business generation plans, market analysis & strategic marketing
• Financial planning, budgeting & product pricing, generating cash flow
• Procurement of medicines, vendor management & supply chain management
• Handled complex & sensitive issues
• Quoted by media several times in interviews & given programs on national radio
• Participated in workshops & wrote on health topics in newspaper
Medical Transcriptionist- Oct 1998 - Jan 2000
Heartland Ltd, Delhi India
Achievements & Contributions: • Hands on experience of writing transcripts from audio files
• Expert in Medical Terminology
• Knowledge of ICD9 & ICD10
• Knowledge of process needed in a MT unit
• Abreast knowledge of Quality Assurance in MT & the metrics involved according to AAMT
(University of Mauritius) Special Management & Entrepreneurship course for SME's (Mauritius Employer's Federation) Entrepreneurship Training Workshop (Empretec Mauritius & UNCTAD)
Postgraduate Diploma in Hospital Administration (Medvarsity & Apollo Hospitals India) Bachelor of Medicine & Surgery - 1996 - 2002 (Nehru Medical College - Delhi University) Short Course in Clinical Auditing