Shweta Nikam

Result oriented professional with 3.5 years of experience in insurance fraud investigation. Expert in health claims, seeking opportunities in the field of investigation and application of clinical knowledge. Currently driving cashless health investigation across west zone. Passionate about process improvements and working with cross functional teams, I actively contribute to collaborative success leveraging diverse perspectives for optimum result.

Investigation Professional - ICICI Lombard

• Develop investigation strategies and plans to ensure thorough and accurate claim assessments.
• Collaborate with legal and policy teams to ensure claims are processed in compliance with legal and internal company standards.
• Investigated Cashless claims of retail (I Bank) of west zone

Health and PA Investigation Officer - SBI General Insurance - Thane

(2022-12 - 2025-02)

Health and PA investigation SBI General Insurance Company

• Learned and adapted quickly to new technology and software application
• Investigated Cashless claims of both retail and corporate of west zone
• Done post cashless project claims along with case study
• Maintained TAT and quality control as per organization goal for cashless and in depth investigation
• Vendor management with vendor training
• Identifying the fraudulent hospital involved in violation of SOP/ANH/bundling and taking corrective measures
• Maintaining MIS and presentation
• Handling grievance and escalations from hospitals and patients

DMO (Duty Medical Officer) - PKC Hospital - Vashi, Navi Mumbai

(2022-03 - 2022-10)

Private hospital - only bank statement available

• Worked in Casualty and Wards
• Assisted in normal labors, done orthopedic dressings with other surgical dressings, RT insertion, catheterization

JMO (Junior Medical Officer) - NMMC Hospitals - Vashi, Navi Mumbai

(2021-04 - 2022-02)

• 4 months of experience in Covid 19 - Cidco Covid Center, Vashi
• 6 months of experience in ICU and Trauma care - FRU NMMC hospital, Vashi
• Done Intubation, CVP line insertion, lumbar puncture, ABG
• Death declaration and Death certificates

RMO (Resident Medical Officer) - Sai Nursing Home - Satara

(2020-05 - 2021-03)

• Internship done in Homeopathic OPD
• Along with internship done RMO duty in Obg/Gynec Hospital
• Assisted many operations - LSCS, abdominal hysterectomy, vaginal hysterectomy, vault prolapse surgery, D & C
• Learnt IUI, taking stitches and removal

BHMS - Homoeopathic Medicine - Sawkar Homoeopathic Medical College (2020-02-20) Satara

HSC - Science - K B P Jr. College of Science (2015-06) Satara

SSC - North Mumbai Welfare Society High School (2013-06-07) Mumbai