Maximus, WDMS & Life-Asia
AJAY KUMAR PANDEY
Claim Processing & Investigation
Noida,UP
Summary
Experienced in claims processing within the personal lines of insurance industry. Strong background in effectively communicating with internal and external parties such as hospitals and investigating agencies. Proficient in utilizing common software programs and office tools for efficient claim processing. Over 14 years of work experience as a Claim Analyst, specializing in Critical Illness, PTDB, ADB rider, and Death claim cases. Skilled in handling claim intimation, registering claims in Life-Asia software, and conducting industry checks while working with software like Maximus and Phoenix. Licentiate from the Insurance Institute of India in Mumbai. Proficient in MS Office, preparing MIS reports, and working on Life-Asia and Omni-flow Software (WDMS).
Overview
16
16
years of professional experience
2
2
Languages
Work History
Claim Facilitator Representative
Niva Bupa Health Insurance
03.2023 - Current
- PACI-Pre-QC,
- Allocation, Pan India,
- Follow-up”,
- Industry Checks.
- Working with software: Maximus, Phoenix, and WDMS.
- Enhanced program effectiveness by collaborating with colleagues to review and revise curriculum content regularly.
- Increased participant engagement by incorporating interactive activities and group discussions into sessions.
Senior Claim Processing Executive
Sahara India Life Insurance Comp. Ltd.
01.2015 - 02.2023
- Claim handling.
- Review claims intimation, assigned to the investigation.
- Recommendation of Critical Illness, PTDB, ADB rider, and death claim cases.
- Arrange Claim Review Committee meetings.
- Dealing with outer agencies (hospitals, investigating agencies, etc.).
- Phoenix, Maximus, and Omni-flow Software (WDMS)
Claim Processing Executive
Sahara India Life Insurance Company
08.2009 - 02.2023
- Claim Investigator from 2009 to 2015 (6 years) and backend support.
- Documents scan and export in Omni-Flow software, and generate a letter.
- Claim handling from claim filling in the system (Life-Asia), intimate documentation. requirements.
- Using Life-Asia and Omni-flow Software (WDMS).
- Dealing with outer agencies (hospitals, investigating agencies, etc.).
Education
Bachelor of Arts - Company Law and Secretarial Practice
Kalicharan Degree College, Lucknow University.
Lucknow, India 04.2001 - 2005.01
Licentiate - Insurance
Insurance Institute of India
Bombay, INDIA 01-2010
12th - Science
Khalsa Inter Collage
Lucknow, UP, India06-1998
10th - Science
Khalsa Inter Collage
Lucknow, UP, India06-1998
Skills
Proficient in MS Office
PERMANENT ADD
MAYA NIWAS, H. No.- 274/64/71, Ninth Street Roza Bagh Rajendra Nargr, Lucknow, 226004
CURRENT ADD
H. No.- 300, Block-H, Sector-22, GB Nagar, Noida, Uttar Pradesh, 201301.
Software
Timeline
Claim Facilitator Representative
Niva Bupa Health Insurance
03.2023 - Current
Senior Claim Processing Executive
Sahara India Life Insurance Comp. Ltd.
01.2015 - 02.2023
Claim Processing Executive
Sahara India Life Insurance Company
08.2009 - 02.2023
Bachelor of Arts - Company Law and Secretarial Practice
Kalicharan Degree College, Lucknow University.
04.2001 - 2005.01
Licentiate - Insurance
Insurance Institute of India
12th - Science
Khalsa Inter Collage
10th - Science
Khalsa Inter Collage
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