ATMARAM ARVIND PARAB
Health Insurance - Claims & MIS
Thane
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
20
20
years of professional experience
1
1
Language
Work History
Lead - Health Claims
SBI General Insurance
Mumbai
04.2010 - Current
- PAN India Health Indemnity claims management of SBI General Insurance
- Effective management of TPA’s operations via effective liaising with all TPA’s
- TPA Fees modeling and payouts
- Training to TPA as well as SBI General Health claims team on various new guidelines issued by regulators / new products
- MIS & Reporting management
- Monthly / yearly claims data management
- TAT / cost control analysis
- Regulatory reports
- Various dashboards as required by Management
- Actively involved in IT developements with regards to more automations
- Managing Audits like TPA, Internal, Statutory, CAG, external vendors
- Achievements:
- Awarded by CEO clubs in 2017
- Developed a new health claims system
- Manage claims & data from government policy in 2021-22 – Ayushman Bharat Punjab
- Promoted 4 times in 11 years of tenure of SBI General and since Mar-19 annual appraisal rating was top.
Operation & MIS Manager
Dedicated Healthcare Services TPA (India) Pvt. Ltd
06.2009 - 04.2010
- Administering and supervising the entire health insurance claim operations
- Providing front-end customer service with quality assurance and handling griviences
- Providing front-end customer service with quality assurance and handling inbound calls on customer queries and concern and providing solutions
- Monitoring and supervising the day-to-day activities of the claim processing department
- Coordinating with Insurance offices regarding speedy settlement of the claims
- Corresponding with the clients on all levels and Insurance offices about their queries and grievances to ensure customer satisfaction
- Organizing and participating in meetings and conferences of the Insurance Companies to ensure flawless operations
- Coordinating with the departmental staffs located in other regions for speedy settlement of the claim
- Generating, preparing and sending daily/ monthly reports to the departmental heads and Insurance offices
- Prepared SOP & opertaing manuals of the process
- Auditing of claims above 25000
- Assessment & scrutiny of claims
- Conducting refresher training to team members
- Checking of all MIS before sending
- Liasoning with client for MIS queries
- Achivements:
- Handling entire claims portfolio i.e., Claim processing, Final Approval, Query team, Storage of claims
- Handling MIS & analysis team
Executive
3i Infotech Pvt Ltd
Mumbai
10.2007 - 06.2009
- Handed team of 50 employees for Regulus Offshore Data Entry project
- Maintaining TAT and productivity for the project
- Preparing statistical analysis of monthly work done
- Preparing MIS like loss ratio, profit & loss statement
- On the basis of data received from client costing has to be prepared
- Analyzing productivity of running processes
- Preparing roll out plan for new projects
- Client interaction for their needs to be satisfied
- Project management
- Process improvement
- Achievements:
- By doing the current process changes & implementing cost saving rule in current ongoing process for Bharti AVCV, the project came in to 20% profit as compare it was in 10% loss earlier
- Have been team member of the integration team which was responsible for merging the subsidiaries of 3i Infotech into the parent company
- It was a Herculean task where in I was responsible for the collection and validation of the data pertaining to people and projects for the departments HR, admin, accounts, IT and projects.
Customer Service Manager
ICICI Lombard General Insurance Company
04.2007 - 10.2007
- Handling Claim Processing of ICICI Lombard health claim policies
- Maintaining claims database as well as enrollment database
- Preparing MIS like loss ratio, P&L statement, Average claim size, Disease classifications
- Analysis of database as per requirement
- Working on software with ICICI, IT team for preparing software for health claims management
- Overall monitoring team of 15 persons
- Following with vendors for printing of health cards, Data entry
- Maintaining the records of inward & outward
- Assessment of PA claims
- Investigation of PA claims
- Maintenance of Network data and coordination with network Hospitals & Diagnostic centers as per requirement
- Coordinating with out station CS locations for smooth operational functions
- Reconciliation of data with Accounts & operation team
- Achievements:
- Reconciliation of Data for one of the Govt
- Mass policy and recovery of claims payout amount running into Lacs of rupees
PARAMOUNT HEALTH SERVICES PVT.LTD
02.2003 - 04.2007
- A Joint venture with MunichRe one of the largest reinsurance companies of the world) in Operations (, Outstation Coordination Dept In charge:
- Preparing statistical analysis of monthly work done and presented in front of management for all branch offices as well as for HO
- Active involvement in overall operational functions as per the decision & instruction by the management in all branch offices
- Responsible for maintaining Operational flow in each branch office
- Keeping regular track of work done by each person in each branch office
- Processing the claim files
- Co ordination with all branch offices to meet their financial as well as other requirements
- Regularly checking the quality of work in all branch offices
- Visiting branch offices for checking workflow
- Key Responsibilities:
- Auditing Claims of Claim Amount above Rs
- 25000/-
- Providing Daily, Weekly and Monthly MIS on Insurance Company wise Claim Settlement as well as work done by branch offices as per need of management
- Visiting Outstation offices for auditing as a part of Quality Improvement Team
- Checking Input & Output process activity of all branches from HO
- Increase Productivity Work
- Control Turn Around Time (TAT) on Claim Settlement
- Co-ordinate with Insurance Company regarding to Settlements
- Additional Responsibility:
- Domiciliary Claim Settlement Processing
- Processing Claims of Public as well as Private Sector Insurance Company
- Preparing Benefit Charts Public as well as Private Sector Insurance Company
- Processing Knowledge of Maternity Claims, Health Check Up and GPA Claims
- Coordination with IT department for up gradation in software
- Preparing various MIS as per requirement
Education
Bachelor Of Science - Statistics
Mumbai University
Higher Secondary school Certificate (H.S.C) - undefined
Maharashtra State Board
S.S.C - undefined
Maharashtra State Board
Skills
Thorough knowledge of healthcare products and claims processingundefined
Timeline
Lead - Health Claims
SBI General Insurance
04.2010 - Current
Operation & MIS Manager
Dedicated Healthcare Services TPA (India) Pvt. Ltd
06.2009 - 04.2010
Executive
3i Infotech Pvt Ltd
10.2007 - 06.2009
Customer Service Manager
ICICI Lombard General Insurance Company
04.2007 - 10.2007
PARAMOUNT HEALTH SERVICES PVT.LTD
02.2003 - 04.2007
Bachelor Of Science - Statistics
Mumbai University
Higher Secondary school Certificate (H.S.C) - undefined
Maharashtra State Board
S.S.C - undefined
Maharashtra State Board
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