Preeti Borra
Noida
Summary
A dynamic professional with rich experience in the areas of Life and health insurance, risk analytics, death disability and health care management, litigation and grievance management, training, automation and system management, claim investigations, operational risk and compliance management, process transition and team management across diverse industries. Extensive experience in managing claims of product portfolios, scrutinizing supporting papers, books of accounts as per requirement & submitting assessment reports.
Overview
11
11
years of professional experience
9
9
Certification
1
1
year of post-secondary education
Work History
Sr. Medical Summarizer/Quality Compliance Analyst
Draft n Craft Legal Outsourcing Pvt. Ltd.
New Delhi
02.2018 - Current
- Serving customers by providing insurance claim expertise to process life and health claims and resolving product and service problems.
- Processing of policy holder’s claims pertaining to health/life, property & causality. Highlighting any misrepresentations or any discrepancies from medical records and financial documents and deciding on viability of claim.
- Review insurance policy terms and conditions in order to determine whether a particular loss is covered by insurance company as per the defined guidelines.
- Liaised with other departments in direct contact with customers such as facilities office, providing them the necessary technical support and expertise to manage customer expectations.
- Maintains claim records by updating claim information, escalations, and special instructions on specific claims.
- Maintaining accurate information in customer database and entry and tracking of various insurance products in life/health & property/causality insurance.
Senior Associate (Claim Management)
EXL Service.com (I) Pvt. Ltd
Noida
07.2010 - 07.2017
- Checking, inspecting and authorizing the processing of claims within the department and responsible for reviewing the deliverables of the team.
- Investigating and solving customer’s complex problems and queries regarding claim transactions and providing them with prompt resolution within stipulated timelines of 24 hours.
- Managing end to end claims for US based insurance client (life and health/property and casualty) to ensure settlement of claims and payment to the claimant within the stipulated time frame.
- Regularly review individual claims within the portfolio and keep reserves and records up to date as required by claims controls and standards.
- Have thorough knowledge of industry regulations and minimum standards to ensure compliance with the regulations and claims control standards and protocols.
- Monitored and reviewed Efficiency levels and SLAs of executives handling operational work.
- On average, 20-30 claim files are received per week.
- To maintain claim documents that include claim forms, policy details, policy status, medical and financial records of all the claimants, review medical information and identify any misrepresentations or exaggerations of medical issues
Education
Bachelor in Homoeopathic Medicine And Surgery - Homoeopathic Medicine And Surgery
Dr. B. R. Sur Homoeopathic Medical College
New Delhi05.2009
High School Diploma -
S.K.V Senior Secondary School
New Delhi 05.2002 - 05.2003
Skills
- Processing medical claims
- Policy compliance understanding
- Medical terms and procedure knowledge
- Quality Management System Compliance
- Medical test reviews
- Medical claims coding
- HIPAA guideline compliance
Certification
o Principles of US Health care management (USHCM 117)
o Principles of US P&C Commercial Liability Insurance (USCL 109)
o Principles of US Property and casualty claims (USC 110)
o Principles of US life insurance products (USLI 112)
o Principles of US life insurance products (USLI 111)
o Principles of US commercial property insurance (USCP 108)
o Principles of US Disability and Long Term Care insurance (USDLTC 106)
o Principles of US Health Regulation and HIPAA (USHRH 114)
Principles of US Medical Expense Insurance (USME 104
Accomplishments
- Member of Indian Institute of Homoeopathic Physicians (IIHP), Delhi State Branch.
- Received extra miller award
- Received Star performer awards many times.
- Received Champ at work.
- Received long service award in 2015.
- Received best employee of the month in Jan and Feb 2020.
Timeline
Sr. Medical Summarizer/Quality Compliance Analyst
Draft n Craft Legal Outsourcing Pvt. Ltd.
02.2018 - Current
Senior Associate (Claim Management)
EXL Service.com (I) Pvt. Ltd
07.2010 - 07.2017
High School Diploma -
S.K.V Senior Secondary School
05.2002 - 05.2003
Bachelor in Homoeopathic Medicine And Surgery - Homoeopathic Medicine And Surgery
Dr. B. R. Sur Homoeopathic Medical College
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