Dr Abdul Nabi Email and Phone Number

1) Medical Opinion and Review- Reviewing claims referred by the medical processors and provide opinion on admissibility as per policy terms- Maintaining SOP for decisions taken on complex issues for future reference- Assisting in sending responses to queries on decisions made on cashless claims2) Effective Fraud Investigation –- Monitoring effective investigation by the internal team and assist them with required inputs- Identifying and referring suspicious claims… Show more 1) Medical Opinion and Review- Reviewing claims referred by the medical processors and provide opinion on admissibility as per policy terms- Maintaining SOP for decisions taken on complex issues for future reference- Assisting in sending responses to queries on decisions made on cashless claims2) Effective Fraud Investigation –- Monitoring effective investigation by the internal team and assist them with required inputs- Identifying and referring suspicious claims for investigation and help the investigation team to solve fraudulent claims - Analyzing and identifying suspicious trends in claims across hospitals/ locations, which helps to find out fraud prone areas or hospitals, thereby control the same through detailed investigation3) Customer Grievances related to Medical Management- Reporting grievances and implementing effective resolutions by coordinating with internal and external stakeholders- Handling effectively customer grievances to increase customer satisfaction- Resolving grievances and identifying the root cause to avoid future occurrence of the same4) Litigation Review- Reviewing claims for which legal notices have been received- Deciding on reconsideration of claims based on policy terms- Preparing claim notes supporting the decision or for reversing earlier decisions with adequate explanation- Preparing responses for litigation team to explain the decisions taken on claims5) Training for Products / Processes Medical Advancements- Organizing trainings to sensitize team on important clauses in health products- Sensitizing medical processors on ways to handle complex cases.6) Travel insurance overseas health claims processing. Show less

1.Verify appropriate selection of adverse event and appropriate MedDRA coding for each adverse event as needed. 2. Verify appropriate selection of seriousness criteria for adverse events. 3. Provide/verify accuracy of label assessment for serious adverse events. 4. Provide company causality assessment for all serious cases. 5. Provide Client Company’s medical evaluation comment.

1. Q/C of book in (inward) and Data entry of health claims.2. Checking Ailment Wise ICD & Procedure Coding (CPT)3. Providing Medical opinion for Health Insurance4. Processing of Cashless Requests & Health Insurance Claim Documents5. Medical Scrutiny.6. Understanding of Policy terms & conditions & Various Protocols / Guidelines.7. Understanding of Claims adjudication / Claims Processing, Maintaining & Ensuring Standard Operating Procedures & Protocols8. Manage volumes… Show more 1. Q/C of book in (inward) and Data entry of health claims.2. Checking Ailment Wise ICD & Procedure Coding (CPT)3. Providing Medical opinion for Health Insurance4. Processing of Cashless Requests & Health Insurance Claim Documents5. Medical Scrutiny.6. Understanding of Policy terms & conditions & Various Protocols / Guidelines.7. Understanding of Claims adjudication / Claims Processing, Maintaining & Ensuring Standard Operating Procedures & Protocols8. Manage volumes effectively & efficiently to maintain Turnaround time of processing cases9. Triggering suspected fraud cases for investigation to investigation team.10. Claim Case Management / Cost Management Show less

 Acting as coordinator between Consultants, patients, nurses and DMOs.  Conducting morning round in the hospital.  Complying with patient safety policy.  Ensuring compliance with healthcare regulations and safety standards.  Making SOPs related to different departments and implementing them.  Working as a member in EMR selection committee of AHLL.  Training-(1). Took “Infection control measures” Training of Nursing staff. (2). Took “patient safety” Training of nursing staff. … Show more  Acting as coordinator between Consultants, patients, nurses and DMOs.  Conducting morning round in the hospital.  Complying with patient safety policy.  Ensuring compliance with healthcare regulations and safety standards.  Making SOPs related to different departments and implementing them.  Working as a member in EMR selection committee of AHLL.  Training-(1). Took “Infection control measures” Training of Nursing staff. (2). Took “patient safety” Training of nursing staff.  Implementing and monitoring of NABH and other Quality Improvement Programs. Show less