Deputy Manager Operations
Aditya Birla Health Insurance Co. Ltd.
Total years of experience :15 years, 4 Months
Responsible for end to end case management of all health claims. Responsible for accurate claim assessment and speedy claim decisions within the stipulated IRDA guidelines. Ensuring quality decision within the agreed SLAs. Liaise with zone team and investigators. Verifying all documents received. Updating information in the Claims System. Quality reviews and report submissions to IIB and IRDA. Responsible for PPC/ PHPC reports in MIS. Managing data for all claims. Calculation for ACS, LR. Data anaylsis of claims on various parameters to identify trends which help to recognize leakages and cause for the same.
-Managing cashless pre-authorization/ pre-approvals of medical claims.
-Processing medical claims.
-Medical claims investigation.
-Medical claims approval.
-Working on and maintaining TAT.
-Continual checking of tariffs of hospitals.
-Building and analyzing TAT band reports and apply improvisations if any.
-Being updated with various health/ medical policies and products in the market.
• On-call Patient Counseling.
• Prescription reading & information recording on software.
• Project handling (individual and team).
• Project data analysis.
• Literature Research.
• Client Coordination.
• Pharmacy informatics.
• Dispensing medicine.
• Educating patients with regards to disease and their medicines.
• Maintaining stock/ Inventory.
• Managing subordinates.
• Literature Research.
I Company: Archirodon Construction Overseas Co. S.A., UAE
Designation: Insurance Officer
Period: May -2007 till April 2010
Job Profile: • Arrangement of Insurance cover to the employees.
• Maintenance of databases.
• Processing of various claims
• Claims verification
• To make reports and statistics for medical history of an employee.
• To acquaint oneself of legal terms.
II Company: Archirodon Construction Overseas Co. S.A., UAE
Designation: Medical Co-ordinator
Period: Dec 04 to May - 07
Job Profile: • To maintain employee medical history.
• Conduct a presentation to discuss various medical cases with management.
• To make various reports (expenses, history, list of chronic patients, etc)
• To maintain relationship with various hospitals, pharmacies, clinics.