Summary
Overview
Work History
Education
Skills
Personal Information
Languages
Languages
Timeline
Generic
Avinash Sawane

Avinash Sawane

Pune,Maharashtra

Summary

Health insurance professional with 4 years of experience in claims Assessment and dispute redressal, with expertise in policy interpretation, clinical validation, process optimization and contributing positively towards organizational growth as well as personal growth.

Overview

3
3
Languages
4
4
years of professional experience

Work History

Health Claims Assesment Specialist

Bajaj Allianz Genaral Insurance Company
Pune
11.2024 - Current
  • Managed claims process from initial notification to final settlement, ensuring efficient handling of cashless and reimbursement claims.
  • Resolved disputes by interpreting policy terms and ensuring service provider compliance with regulations through policy interpretation and clinical validation.
  • Coordinated with TMA and clients to gather medical documents for self-pay cases, facilitating timely resolution of claims.

Medical Claims Processor

MDIndia Health Insurance TPA Private Limited
Wadgaon Sheri, Pune
09.2023 - 11.2024
  • Reviewed patients' medical records for completeness, ensuring inclusion of medical history, examinations, diagnostic test results, treatment plans, progress notes, and discharge summaries.
  • Verifying the accuracy of diagnostic and procedural cluster codes used for billing purposes, ensuring alignment with clinical documentation and the company's protocols and guidelines.
  • Participated in internal and external audits and assisted in resolving audit findings.

SPS Associate

Amazon Development Centre (India) Private Limited
Remote
05.2022 - 05.2023
  • Provided operational support to 3rd party sellers on Amazon platform, ensuring accuracy and timeliness to enhance seller experience.
  • Resolved escalated issues from irate customers, ensuring satisfaction and maintaining positive relationships.
  • Collaborated with cross-functional teams to identify root causes and implement effective solutions.

Education

BDS -

MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES
NASHIK

HSC -

MUMBAI DIVISIONAL BOARD

SSC -

MUMBAI DIVISIONAL BOARD

Skills

  • Claims management
  • Regulatory Compliance
  • Quality assurance
  • Attention to detail
  • Effective communication
  • Interpersonal skills
  • Teamwork
  • Adaptability

Personal Information

Title: BDS

Languages

Title: BDS

Languages

English
Proficient
C2
Hindi
Proficient
C2
Marathi
Proficient
C2

Timeline

Health Claims Assesment Specialist

Bajaj Allianz Genaral Insurance Company
11.2024 - Current

Medical Claims Processor

MDIndia Health Insurance TPA Private Limited
09.2023 - 11.2024

SPS Associate

Amazon Development Centre (India) Private Limited
05.2022 - 05.2023

BDS -

MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES

HSC -

MUMBAI DIVISIONAL BOARD

SSC -

MUMBAI DIVISIONAL BOARD
Avinash Sawane