DR. Preethi Chandravadhani. R
Bengaluru
Summary
To be a part of an organization where in talents are recognized and skills are utilized there by fueling constant growth for the concern and Career. Consummate Claims Associate knowledgeable in insurance coverage, policy terms and conditions. Facilitates claims processing by cultivating productive relationships with stakeholders. Blends analytical and administrative acumen throughout investigations and recommendations.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Senior Medical Officer/Case Manager
Onsurity Technologies Private Limited
Bengaluru
05.2023 - Current
- Joined as Senior case manager and Handled health claims for Corporate and auditing Cashless claims processed by TPA.
- Good experience in handling irate customer and denial clarifications to customers
- Escalated and duly follow-ups with concern TPA in regards of delay in Cashless claim processing and wrong claim adjudications.
- Conducted follow-up meetings with the Cashless Team (Team building) regarding claim handling, triggering investigations / verifications for fraud claims and resolve the escalations (I/v/o delayed claim processing, Wrong claim adjudications- Deductions, Sublimit, Co-pay oriented clarifications)
- Regular follow-up with customers in the entire claim process in both mail and call communications.
- Handled reimbursement claims and clarified doubts / escalations from customers based on Coverages and Wellness benefits
Senior Associate 1
Digit Insurance
Bengaluru
01.2022 - 04.2023
- Joined as senior associate 1 in Health claims team Digit Insurance, Bangalore, Karnataka
- 15 months of experience - Handled and processed benefit and Indemnity claims
- Handled High value Death and disablement claims as per corporate and Policy norms
- Handled Cashless and Reimbursement claims both GMC(Corporate) and Retail products in Digit insurance
- Suggested ideas for betterment /System friendly processing(claims)- Which were implanted also
- Recently got an award for Best weekly performance for the month of November Week(2023)
- ACE SAVIOUR award/Appreciation received Twice for the month of July and August(2023) saving around 10L under negotiation, Fraudulent/ Investigation and error processing by the TPA.
Medical Manager
Star Health Insurance Limited
Chennai
07.2017 - 12.2021
- 4+ years of experience in insurance field (claim processing) in various departments such as cashless / pre-approval, reimbursement, grievances and auditing
- Handled high value cashless/claims processing and marketing escalations
- Examine medical treatment records, medical bills to gauge overall extent of liability and follow on lapsed claims
- Handled grievance complaints from customers, review and provide medical opinion
- Provide elaborate justification for deductions/rejections made as per policy norms
- Assist team members with account issues, and providing knowledge about the accounts
- Reject or access documentation, determine benefit due, and start the denial or payment process to resolve medical claims
- Resolved complex claims-processing issues
- Participated in quality-control audits and monitor status updates
- Adhere to all company policies, procedures and guidelines in addition to insurance regulations at the federal and state level
- Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable
- Coordinate with Hospitals, Medical and claims team
- Reconfirm & assure smooth flow of documents for all transactions processed and registered
- Resolve the queries of the clients related to payable
- Provide Pre-Authorization and Final Approvals according to the Insurance policy
- Contact customers in order to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
Education
BDS - Dental Sciences
Karpaga Vinayaga Institute of India
Chengalpet,India10-2016
High School Diploma -
St.James Matriculation Higher Secondary School
Tamil Nadu04-2011
Skills
- Processing medical claims
- Medical claims submission
- Claims analysis & review
- Medical history analysis & collection
- Leadership
- Regulatory Knowledge
- Quality Improvement
Affiliations
- Affiliated by Dental Council of India
- Completed Senior Internship at Stanley Government Hospital, Chennai ,Tamil Nadu from Feb 2017 to Aug 2017
Additional Information
Worked as a Senior Internship in Stanley Government Hospital, Chennai from Feb 2017 to Aug 2017, Also, worked as an Assistant dental surgeon at Tooth Shine Dental care at Chrompet Chennai-Under renowned Prosthodontist Dr. Arun Raj MDS
Languages
Tamil
First Language
English
Proficient (C2)
C2
Hindi
Beginner (A1)
A1
Certification
- Undergoing Licentiate from III- LIII
Clinical Experience
- Worked as an Assistant Dental surgeon at Tooth Shine Dental care at Chrompet , Chennai, Tamilnadu under Reowned Prosthodontist-Dr.Arun Raj MDS.
Accomplishments
- Organized field visits in rural as well as urban areas during the INTERNSHIP and diagnosed various dental cases and provided dental treatments.
- Attended Live Surgical Workshop in Oral and Maxillofacial surgery held at Tagore Dental College & Hospital on 22.12.2015. Attended 34th Annual Conference Association Of Anatomists –Tamilnadu. ANATCON @ MAPIMS 2011.
- Participated in the 3rd National Conference of Society of Biological Scientists of India at KarpagaVinayaga Institute of Medical Sciences &Research Institute,Won prizes in dance competitions in IDA conferences held at Villupuram(2013), Namakkal(2014) , at Vivekanandha Dental College(2011), Sri Venkateshwara Dental College(2016).
Timeline
Senior Medical Officer/Case Manager
Onsurity Technologies Private Limited
05.2023 - Current
Senior Associate 1
Digit Insurance
01.2022 - 04.2023
Medical Manager
Star Health Insurance Limited
07.2017 - 12.2021
BDS - Dental Sciences
Karpaga Vinayaga Institute of India
High School Diploma -
St.James Matriculation Higher Secondary School
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