Subhash Rawte Email & Phone Number

Dubai, Ae

Andheri, Mumbai, Maharashtra, India

As an experienced Claims Manager in the Insurance & Healthcare industry, I bring over 10 years of expertise in managing medical claims portfolios, both for international claims and self-funded insurance clients. My proficiency spans cashless and reimbursement claims processing, ensuring compliance with policy terms and regulations while maintaining the highest standards of accuracy and efficiency.I excel at liaising with hospitals, clients, and key stakeholders to facilitate seamless claims processing and effective issue resolution. My responsibilities include overseeing claim settlements, addressing discrepancies, and managing the financial aspects related to claims, such as payment adjustments.With a strong attention to detail and the ability to handle multiple claims simultaneously, I am committed to delivering exceptional service and maintaining high levels of client satisfaction. My analytical skills enable me to assess data trends and produce insightful reports to inform decision-making and operational improvements.I am passionate about leveraging my expertise to drive positive outcomes in the healthcare and insurance sectors.

Filed medical claims made by customers by entering and organizing data and inputting all information into the customer management system.Determined the amount of coverage and sent payments to medical facilities for reimbursements to customers.Reviewed and ensured completed insurance claim forms and related documents.Reported missing information and attached information to claim file.Communicating with other department and functions for additional and missing information.Reviewed insurance policy to determine coverage.Auditing and verifying documentation of claims cases.Managing ageing claims by communicating with managers and other stakeholders.Preparing different MIS reports and publish across to the top management.Allocating pending cases within team and ensuring the completion of task.Managing proper filling of the records such as Insurance claim, reimbursement claim and other relevant documents.Responsible for processing insurance claims quickly and efficiently as well as investigating claims issues and keeping patient files updated along the way.Coordinating with hospital for cashless claims and acquiring claims detail for processing cashless claim and providing the approval for the claim.Coordinating with client/HR to update the claim status of a reimbursement claim and provide a proper claim status.Maintain MIS report of the Monthly/Yearly received claim both cashless and Reimbursement.

Bachelor Of Commerce, Commerce

High School

High School