Ashish Shukla
Varanasi
Summary
Dynamic hospital consultant with a proven track record at Holy City Hospital, excelling in operational analysis and business development. Expert in compliance auditing and process improvement, I have successfully enhanced claims management systems, fostering partnerships that elevated brand recognition and streamlined organizational efficiency. Strong analytical skills combined with effective communication drive results.
Overview
21
21
years of professional experience
Work History
Hospital Consultant
Holy City Hospital and Trauma Centre
Varanasi
12.2020 - Current
- Provided advice on operational processes, business development initiatives, organizational changes and other areas of improvement.
- Developed partnerships with local businesses to grow brand recognition in the community.
Hospital Corporate Head
Dirghayu Hospital and surgical centre
Varanasi
05.2013 - 11.2020
- Conducted audits of third party administrators for compliance with service level agreements.
- Developed and implemented procedures for tracking claims and payments, as well as monitoring the overall performance of health care plans.
- Trained new staff members on TPA policies and procedures while providing ongoing support and guidance throughout their employment period.
- Prepared reports on claim activity, financial transactions, plan costs, and usage analysis for management review.
- Coordinated activities among multiple departments such as IT, Human Resources, Accounting and Finance when necessary.
Claims Manager
Family Health Plan TPA
GURGAON
12.2010 - 01.2013
- Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
Claims Processor
vipul medcorp tpa
GURGAON
02.2008 - 12.2010
- Resolved complex issues associated with denied or underpaid claims through negotiation with payers.
- Evaluated the validity of assigned claims by verifying that services are medically necessary according to established guidelines.
- Managed escalated customer complaints pertaining to denied or delayed payments in a timely manner.
- Assisted customers via telephone inquiries related to their specific claim status or general questions about the company's services.
- Reconciled payment discrepancies between provider statements and remittance advice from payers.
- Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
Claims Assistant
paramount health services tpa
New Delhi
02.2004 - 02.2008
- Answered inquiries from customers regarding their individual claims status.
- Reviewed and verified insurance claim forms to ensure accuracy and completeness of information provided by claimants.
- Provided customer service support to policyholders, claimants, and agents over the phone or via email.
- Attended monthly meetings with upper management personnel in order discuss any outstanding challenges encountered while processing high volume workloads.
- Processed payments for approved claims within specified time frames.
- Generated correspondence to customers regarding claim decisions or other pertinent information.
- Maintained accurate records related to all aspects of the claims process.
- Performed quality control checks on completed files prior to final submission for payment authorization purposes.
- Investigated and resolved discrepancies in claims data entries.
- Assisted in the preparation of documents for claims processing.
- Assisted with the resolution of complex insurance claim disputes between policyholders and insurers.
Education
GED -
Delhi University
06-2005
High School Diploma -
Sarvodaya School
Saket DelhiSkills
- Operational analysis
- Compliance auditing
- Process improvement
- Claims management
- Policy development
- Data analysis
- Business development
Accomplishments
- awarded Man of the Match in college cricket tournament in 2004
Affiliations
- participated in annual Training camp of Scouts in school days
- Member of National Social Scheme( N.S.S School level)
Languages
English
Intermediate (B1)
B1
Hindi
Advanced (C1)
C1
Timeline
Hospital Consultant
Holy City Hospital and Trauma Centre
12.2020 - Current
Hospital Corporate Head
Dirghayu Hospital and surgical centre
05.2013 - 11.2020
Claims Manager
Family Health Plan TPA
12.2010 - 01.2013
Claims Processor
vipul medcorp tpa
02.2008 - 12.2010
Claims Assistant
paramount health services tpa
02.2004 - 02.2008
GED -
Delhi University
High School Diploma -
Sarvodaya School
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