Dr. Foram Kapdi
Senior Manager
Mumbai
Summary
Proven leader in insurance and healthcare management, adept at driving operational excellence and enhancing customer satisfaction across Prudent Insurance Brokers and Alliance Insurance Brokers. Expert in underwriting and risk assessment, with a strong focus on leadership and team management. Achieved significant improvements in claims processing efficiency and policy administration, demonstrating exceptional organizational and communication skills.
Overview
9
9
years of professional experience
Work History
SENIOR MANAGER
Prudent Insurance Brokers
Mumbai
07.2024 - Current
- Managing pan India EB claims along with Partner Management and Claims.
- Established strong relationships with clients, along with TAT management of the TPA’s and insurer, along with weekly discussion and plan of action for further clearance.
- Implemented and developed operational standards, policies and procedures.
- Held monthly meetings along with quarterly meetings to enhance the process.
- Project management.
- Developed comprehensive reports for senior leadership outlining project progress, key metrics, challenges faced, and proposed solutions.
- Delivered projects on time and within budget through effective resource allocation and prioritization.
- Improved team collaboration with communication strategies.
- Managed change effectively during major transitions, minimizing disruptions to ongoing operations while delivering desired outcomes.
SENIOR MANAGER
Alliance Insurance Brokers
Mumbai
09.2023 - 06.2024
- TAT Management: Skilled in establishing and maintaining effective TAT benchmarks for claim resolution
- Proactively identify bottlenecks and implement strategies to optimize efficiency and reduce turnaround times, thereby enhancing customer satisfaction
- Optimized claim TATs, enhancing customer satisfaction & efficiency
- Expert in insurance policies, coverage & regulatory compliance
- Analyzed claims data to improve management & strategize solutions.
ASSISTANT MANAGER
Aditya Birla Health Insurance
Mumbai
09.2022 - 10.2023
- Assist the Manager in overseeing daily operations of the health insurance department, including claims processing, policy administration, and customer service
- Supervise and train a team of insurance professionals, providing guidance, support, and performance feedback
- Collaborate with cross-functional teams, such as underwriting, actuarial, and compliance, to ensure seamless workflow and adherence to regulatory guidelines
- Implement process improvements to enhance operational efficiency, reduce costs, and optimize customer satisfaction
- Conduct quality assurance reviews to ensure accuracy and compliance with established policies and procedures
- Handle complex customer inquiries and complaints, resolving issues promptly and maintaining a high level of customer satisfaction
- Evaluated insurance applications and assessed risks to determine appropriate coverage and premiums
- Assist in the development and implementation of training programs for staff to enhance their knowledge and skills
- Participate in strategic planning and goal setting, contributing to the achievement of organizational objectives
- Conducted periodic audits of policy portfolios to ensure compliance with underwriting guidelines and identify potential risks
- Stayed updated on industry trends, regulatory changes, and emerging risks to inform underwriting decisions and policy development.
MEDICAL OFFICER
Vidal TPA
Mumbai
01.2021 - 07.2022
- Evaluated insurance applications and assessed risks to determine appropriate coverage and premiums
- Reviewed incoming applications and supporting documents, such as medical records, financial statements, and claim history
- Conducted thorough analysis of applicant information to determine eligibility and evaluate the level of risk involved
- Collaborated with agents, brokers, and underwriting team to gather additional information and clarify policy details
- Utilized underwriting guidelines and risk assessment models to evaluate applications and determine the terms and conditions of coverage
- Analyzed the potential for losses based on the applicant's profile, industry standards, and market trends
- Reviewed policy renewals and made adjustments as necessary based on changes in risk factors or market conditions
- Provided recommendations for policy cancellations, non-renewals, or premium adjustments when warranted
- Assessed policyholders' claims history, loss ratios, and other relevant factors to determine appropriate actions
- Conducted periodic audits of policy portfolios to ensure compliance with underwriting guidelines and identify potential risks
- Identified patterns or trends in claims data to improve risk assessment accuracy
- Supported the marketing and business development teams by providing underwriting insights and participating in client meetings or presentations.
MEDICAL OFFICER (CLAIM PROCESSOR)
Medi Assist TPA
Mumbai
08.2019 - 10.2020
- Processed and adjudicated insurance claims, ensuring accuracy, compliance, and timely resolution within company guidelines
- Reviewed claim documentation, medical records, and invoices to determine claim validity, completeness, and accuracy
- Conducted investigations into potentially fraudulent activities or irregularities, collaborating with internal departments and external agencies as needed
- Communicated with policyholders, providers, and internal teams to address claim-related inquiries, resolve issues, and provide updates on claim status
- Maintained comprehensive and organized claim files, ensuring confidentiality and adherence to data protection regulations
- Assisted in training new claim processors, sharing knowledge of best practices, company policies, and procedures
- Maintained accurate records of underwriting decisions, correspondence, and policy changes
- Utilized underwriting software and databases to update and track policy information
- Stayed updated on industry trends, regulatory changes, and emerging risks to inform underwriting decisions and policy development
- Attended industry conferences and workshops to enhance knowledge and skills.
DENTAL SURGEON
Royal Dental Clinic
Mumbai
02.2018 - 01.2020
- Performed comprehensive dental examinations, diagnoses, and treatment planning for patients of all ages
- Administered local anesthesia, performed tooth extractions, and conducted root canal therapy
- Placed and restored dental implants, performed crown and bridge work, and carried out cosmetic dental procedures
- Educated patients about proper oral hygiene techniques, preventive care, and the importance of regular dental check-ups
- Collaborated with a multidisciplinary team of dental professionals to develop personalized treatment plans
- Utilized digital imaging technology and electronic dental records for accurate diagnosis and efficient patient management
- Participated in ongoing continuing education courses and conferences to stay updated on the latest advancements in dentistry
- Completed specialized training in areas such as orthodontics, periodontics, or oral surgery
- Attended workshops on practice management, patient communication, and dental technology.
DENTAL SURGEON
Apurva dental clinic
Mumbai
03.2016 - 01.2018
- Provide a wide range of dental treatments, including general dentistry, restorative procedures, and cosmetic dentistry
- Perform dental examinations, diagnoses, and treatment planning for patients of all ages
- Administer local anesthesia and ensure patient comfort during procedures
- Conduct thorough dental cleanings and educate patients on proper oral hygiene practices
- Collaborate with specialists and refer patients as needed for advanced procedures
- Supervise and mentor dental staff, including dental hygienists and dental assistants
- Maintain accurate patient records and documentation of treatments provided
- Stay updated with the latest advancements in dental techniques, technologies, and materials
- Adhere to infection control protocols and maintain a clean and safe working environment
- Implement strategies to enhance patient satisfaction and improve practice efficiency.
Education
BDS - undefined
Maharaja Krishna Kumar Shinji University
HSC - undefined
Maharashtra Pune Board
SSC - undefined
Maharashtra Pune Board
Skills
Leadership and team management
Insurance processes, claims processing, and policy administration
Underwriting, risk assessment, and policy analysis in the insurance industry
Organizational skills, maintaining accurate patient records and documentation
Collaboration with multidisciplinary teams
Utilizing digital imaging technology, electronic dental records, and underwriting software
Professional development, attending workshops and conferences
Comprehensive knowledge and expertise in all aspects of dentistry
Performing dental examinations, diagnoses, treatment planning, and providing appropriate dental care
Administering local anesthesia and ensuring patient comfort during procedures
Communication and interpersonal skills
Microsoft Office Suite (Word, Excel, PowerPoint, Outlook (Basic)
Personal Information
- Date of Birth: 09/12/91
- Nationality: Indian
- Marital Status: Single
Timeline
SENIOR MANAGER
Prudent Insurance Brokers
07.2024 - Current
SENIOR MANAGER
Alliance Insurance Brokers
09.2023 - 06.2024
ASSISTANT MANAGER
Aditya Birla Health Insurance
09.2022 - 10.2023
MEDICAL OFFICER
Vidal TPA
01.2021 - 07.2022
MEDICAL OFFICER (CLAIM PROCESSOR)
Medi Assist TPA
08.2019 - 10.2020
DENTAL SURGEON
Royal Dental Clinic
02.2018 - 01.2020
DENTAL SURGEON
Apurva dental clinic
03.2016 - 01.2018
BDS - undefined
Maharaja Krishna Kumar Shinji University
HSC - undefined
Maharashtra Pune Board
SSC - undefined
Maharashtra Pune Board