Consulting

- Patient Engagement through health care providers for better clinical outcomes, productivity and satisfaction ( Patient engagement software solutions )- Managing health care, financial aids and hospitalization for the needy, low-income, and poor patients, with reliable insurance and proper service.- Arrange Wellness Check Ups, C M Es, Intervention Programs and Disease Management Programs.- Corporate Solutions - networking with Doctors, clinics, pharma units &… Show more - Patient Engagement through health care providers for better clinical outcomes, productivity and satisfaction ( Patient engagement software solutions )- Managing health care, financial aids and hospitalization for the needy, low-income, and poor patients, with reliable insurance and proper service.- Arrange Wellness Check Ups, C M Es, Intervention Programs and Disease Management Programs.- Corporate Solutions - networking with Doctors, clinics, pharma units & diagnostic centre's.- Integration of varied platforms to manage customized solutions with wide network of healthcare providers / Remote Assistance, Care Coordination Show less

- Fund generation to arrange Health & Wellness Camps in different locations,- Entrepreneurship Promotion by formation of Self Help Groups and conversion into beneficiary for micro group insurance schemes promoted by various insurers,- Partner with leading Health facilitators and provide insight towards promotion of Wellness Benefit Plans, Costing, Implementation & Administration through competent service providers,- Preparing groundwork for organizing CME’s, Medical… Show more - Fund generation to arrange Health & Wellness Camps in different locations,- Entrepreneurship Promotion by formation of Self Help Groups and conversion into beneficiary for micro group insurance schemes promoted by various insurers,- Partner with leading Health facilitators and provide insight towards promotion of Wellness Benefit Plans, Costing, Implementation & Administration through competent service providers,- Preparing groundwork for organizing CME’s, Medical camps with local bodies and physician forums,- Employee Communication Strategies and Wellness Program management,- Proven track record in increasing profits, controlling costs and streamlining operations and wellness practices / strategic planning and directed both operations and marketing in the industry,- Meeting referral sources and establishing tie ups to maximize benefits pertain to Healthcare & CSR. Show less

TRADITIONAL Health Claims Adjudication for ICs & other corporates,Cashless process & adjudications,RSBY Pre - empanelments facility survey,identify abuse / fraud, claims data analysis & data compilation.

TRADITIONAL Health Claims Adjudication for ICs - NICL, UIICo., & other corporates,RSBY Pre - empanelments facility survey,RSBY Co - ordination with SNA & Govt. Administration for hospital grievances,Analysis & Drafting audit process through triggers and intimation modules,Claims investigations & adjudication - experience in analyzing claims with regard to Hard or Soft frauds, comparative negligence, proximate cause and admissibility,Exposure to identify abuse / fraud… Show more TRADITIONAL Health Claims Adjudication for ICs - NICL, UIICo., & other corporates,RSBY Pre - empanelments facility survey,RSBY Co - ordination with SNA & Govt. Administration for hospital grievances,Analysis & Drafting audit process through triggers and intimation modules,Claims investigations & adjudication - experience in analyzing claims with regard to Hard or Soft frauds, comparative negligence, proximate cause and admissibility,Exposure to identify abuse / fraud detection and claims data analysis,Ability to differentiate between abuse, fraud and over utilization of claims and data compilation. Show less

Drafting field audit (P2P) protocols and facility review as per SLAs,Strategic Claims investigations & adjudication,Hospital Economics,Administration and review of offered Health Services,Hospital Function, Information System and MRD&Strategic Consulting and Business Plan Development.

Strategic Claims Investigations, providing necessary support to the Health Administration Team for adjudication of Claims received & to identify case on medical admissibility and/or non-disclosure.• Facilitate access into Hospitals, and oversee Claims authorization / Payout process.• Ensuring the validity / feasibility of the claims with high degree of precision and accuracy.• Processing of intimations and forwarding the requirements accordingly based on validity of claim.•… Show more Strategic Claims Investigations, providing necessary support to the Health Administration Team for adjudication of Claims received & to identify case on medical admissibility and/or non-disclosure.• Facilitate access into Hospitals, and oversee Claims authorization / Payout process.• Ensuring the validity / feasibility of the claims with high degree of precision and accuracy.• Processing of intimations and forwarding the requirements accordingly based on validity of claim.• On receipt of complete requirements analyzing and processing the Investigation / claim within the agreed Turn Around Time.• In case of receipt of incomplete requirements regular follow-up with claimants via reminders, telephonic talk, branch operations officers, sales force etc. within the time frame as specified in the Claims Process Guidelines.• Seeking Legal, Medical, Under-Writing and Re insurer opinion wherever necessary to arrive at a decision as to accept / reject the claim.• Coordinating with other departments viz; Operations, Actuarial, Underwriting, Legal etc to expedite processing of claims.• Interact with other functions / departments and collate the final response to communicate back to the customers.• To ensure the quality & Turn Around Time as per desired level.• Resolving branch claim queries as a designated point of contact.# Problem solving, multi - tasking and resolution mission critical# Team selection and development# Communication and performance management# People management and a strong ability to motivate the team Show less

Medical Advisor (Health Insurance & Claims)

• Responsible for maintaining all required documentations of hospital like IPDregister, case sheets, treatment process flow.• Managing OPD of the hospital with Senior Doctors as a Team.• Strategic Hospital Management & Administration, introduced various HealthInsurance Coverages for revenue generation.