Manager - PARAMOUNT HEALTH SERVICES & INSURANCE TPA - PAN INDIA
(2023-09)
Manager holding position in the organization (PSU'S NIAC, OIC, NIC) responsible for overseeing and managing health investigations across PAN INDIA, handling both cashless and reimbursement cases, and conducting comprehensive investigations.
- Responsible for overseeing and managing health investigations in PAN INDIA
- Handles cashless and reimbursement cases, including processing and managing claims and payments for medical services
- Conducts hospital visits and patient visits for health investigations, ensuring accurate data collection
- Performs 360 Degree/Parameter Investigations covering all aspects and parameters related to health cases
- Reviews and examines medical records, analyzing medical history, diagnostic reports, treatment plans, and medications
- Manages reimbursement cases, verifies authenticity of claims and ensures compliance with insurance provider requirements
- Coordinates with patients and hospital companies to resolve queries and issues related to reimbursement cases
- Manages portal intimation process and obtains preauthorization for necessary medical procedures and treatments
- Collaborates with central team (CRM, MEDICAL, CLAIMS) to ensure smooth processing of cases
- Involved in overall investigations including cashless cases, reimbursement cases, Quality Control (QC), audit, recovery, and data analysis
Doctor - Own Clinic - BHOPAL (MP)
(2021)
Running personal clinic with morning 2 hours and evening 2 hours practice. Specializing in cosmetic dermatology and laser treatments with hands-on experience in various aesthetic procedures.
- Training and development of other team members, especially skin practitioners and doctors in various treatment procedures
- Handling billing for various procedures and following up with clients post treatments
- Handling consultations on a day to day basis
- Hands on experience with ND-YAG lasers for permanent hair reduction and photo rejuvenation
- Incorporating innovative ideas and implementing the same for betterment of treatment
- Maintaining inventories and stock verification on a monthly basis
- Maintaining monthly sales reports and lead generation reports
Freelancer QC Manager - Self-Employed - BHOPAL (MP)
(2021 - 2022)
Worked as Quality Control Manager managing health investigations and claim processing.
- Scrutinizing various medical records of patients
- Handling reimbursement cases with spot and cashless cases
Assistant Manager - MAX BUPA HEALTH INSURANCE PVT LTD - MADHYA PRADESH
(2020-11 - 2021-05)
Working as Assistant Manager responsible for health investigations in Madhya Pradesh, managing cashless and reimbursement cases for the entire state.
- Taking care of Health investigation of Madhya Pradesh
- Taking care of cashless and reimbursement cases
- Conducting hospital visits and patient visits for health investigations
- Investigating cases with 360 degree/parameter coverage
- Scrutinizing various medical records of patients
- Handling reimbursement cases with spot and cashless cases of entire MADHYA PRADESH
- Coordinating with patient and hospital companies for resolution of query cases
- Managing portal intimation and obtaining preauthorization
- Coordinating with central team
State Manager (promoted from Senior Executive ILM) - BAJAJ ALLINAZ GENERAL INSURANCE CO.LTD. - Mumbai, Western Line, MP, Chhattisgarh, Bihar, Jharkhand, Nashik
(2018-02 - 2020-10)
Joined as Senior Executive in Loss & Mitigation department dealing with product verification. Promoted to State Manager. Initially responsible for entire western line (Church gate to Palghar) from Mumbai, later expanded to cover MP, Chhattisgarh, Bihar, Jharkhand, and Nashik.
- Joined at Mumbai in 2018 and was taken care of entire western line (From Church gate to Palghar)
- From Aug 2019 – Taking care of MP, Chhattisgarh, Bihar, Jharkhand, Nashik
- Handling spot cases, Hospital audits, PA cases
- Co-ordinating with vendors overseas and investigation in western line Mumbai
- Compilation of daily reports, monthly quarterly reports, and other necessary documents in an orderly manner
- Performing other duties as delegated by reporting authority
- Qualified for international trip in 2018-19, Achieved more than 200% of Target
- In 2019-20 achieved more than 150% of target
Manager (Fraud Control Unit) - RELIGARE HEALTH INSURANCE - VILE PARLE MUMBAI
(2017-02 - 2018-01)
Managed fraud control unit responsible for scrutinizing medical records and handling reimbursement cases across Mumbai.
- Scrutinizing various medical records of patients
- Handling reimbursement cases with spot and cashless cases of entire Mumbai
- Coordinating with patient and hospital companies for resolution of query cases
- Portal intimation and obtaining preauthorization
- Coordinating with central team
Cosmetologist & Consultant Doctor - POISON ANTI AGEING CLINIC - MUMBAI
(2009 - 2016)
Worked in Cosmetic Dermatology department overseeing entire departmental functioning. Specialized in aesthetic procedures, laser treatments, and consultant services.
- Overseeing the entire functioning of the department
- Maintaining monthly sales reports and lead generation reports
- Handling consultations on a day to day basis
- Achieving monthly sales targets
- Maintaining inventories and stock verification on a monthly basis
- Co-ordinating with other in-clinic departments
- Incorporating innovative ideas and implementing the same for betterment of treatment
- Training and development of other team members, especially skin practitioners and doctors in various treatment procedures
- Conducting training programmes for students from Clara International on Lasers (theoretical and practical sessions)
- Assisting Dermatologist for procedures like Botox, Fillers (Restylene, Juvederm), ILS
- Counselling clients for various skin related packages
- Handling billing for various procedures and following up with clients post treatments
- Hands on experience with ND-YAG lasers for permanent hair reduction, photo rejuvenation, chemical peels (glycolic, salicylic, lactic, yellow peels, cosmelan peels), face firming, under eye microcurrent
- Awarded certificate of appreciation for maximum number of excellent scores, maximum number of upsells, maximum number of laser vouchers moved, maximum number of skin health routine moved
R.M.O (Resident Medical Officer) - AGRWAL HOSPITAL - BHOPAL
Worked as Resident Medical Officer under trained physicians and surgeons.
- Working under trained physicians and surgeons, assisting senior consultants for daily rounds and communicating with senior doctors in cases of emergency
- Reviewing and updating information on patients charts as per physicians advice
- Filling in discharge summary
- Taking complete case history of patients on admission
