Dr Priyanka J
Senior Medical Officer
Bangalore
Summary
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Team lead/Assistant Manager position. Ready to help team achieve company goals.
Overview
10
10
years of professional experience
4
4
Languages
Work History
Senior Medical Officer
Mediassist TPA Pvt Ltd
01.2023 - 07.2023
- Worked as Claims Approver for Reimbursement Claims for Client Location that is Mindtree Limited Through third party TPA that is Mediassist TPA Pvt Ltd.
- Scrutinizing all submitted Reimbursement claim documents and approving claims within Specified TAT based on Insurance Policy Terms and Conditions.
- Prior to Rejecting claims, referring claims to Insurance company /Brokers based on Policy Terms and conditions.
- High Value claim approvals were taken from Insurance companies by Co-ordinating with Insurers.
- Internal Departmental Medical opinions for Medical Leaves were taken within Mindtree Corporate via Emails.
Senior Medical Officer
United Health Care Parekh TPA Pvt Ltd
09.2018 - 01.2023
- Worked as Claims Approver for Reimbursement Claims in Client Location that is Mindtree Limited Through third party TPA that is United Healthcare Parekh TPA.
- Scrutinizing all submitted Reimbursement claim documents and approving claims within Specified TAT based on Insurance Policy Terms and Conditions.
- Prior to Rejecting claims, referring claims to Insurance company /Brokers based on Policy Terms and conditions.
- High Value claim approvals were taken from Insurance companies by Co-ordinating with Insurers.
- Internal Departmental Medical opinions for Medical Leaves were taken within Mindtree Ltd Corporate.
- Also worked as TPA Co-ordinator doctor for case to case basis with Employees, Insurer and Employer for Health checkup claims, High value claims, Rejected claims with Insurer and employee for Detailed explaination.
Senior Medical Officer
E-Meditek TPA Private Ltd
10.2016 - 09.2018
- Worked as Claims Approver for Reimbursement Claims in Client Location that is Mindtree Limited Through third party TPA that is E-Meditek TPA Pvt Ltd.
- Scrutinizing all submitted Reimbursement claim documents and approving claims within Specified TAT based on Insurance Policy Terms and Conditions.
- Prior to Rejecting claims, referring claims to Insurance company /Brokers based on Policy Terms and conditions.
- High Value claim approvals were taken from Insurance companies by Co-ordinating with Insurers.
- Internal Departmental Medical opinions for Medical Leaves were taken within Mindtree Ltd Corporate.
Medical Officer
Vidal Healthcare TPA Pvt Ltd
11.2015 - 07.2016
- Verification of Claim documents and advising admissibility of claims based on Insurance Policy Terms and Conditions.
- Claims Experts Opinion is taken prior to any Rejections, Investigations,etc.
Medical Officer
Mediassist TPA India Pvt Ltd
08.2013 - 11.2015
- Worked as a Pre-auth approver in Pre-auth Department.
- Scrutinizing all the documents based on Insurance Policy terms and conditions.
- Approving claims case to case basis post verification of documents within TAT period.
- If any Fraud claims are recognized, then assigning respective claims for Investigation.
- If claim value and claimed amount is on higher end then refer it to Loss Control Measures team for Negotiation with hospital billing team.
- If in case claim gets rejected, then refer it to Insurance company/Brokers prior to Rejections.
Education
Bachelor of Science - Dental Surgeon
J.S.S Dental College And Hospital
Mysore 04.2001 -
Skills
Corporate Relationship Management
undefinedTimeline
Senior Medical Officer
Mediassist TPA Pvt Ltd
01.2023 - 07.2023
Senior Medical Officer
United Health Care Parekh TPA Pvt Ltd
09.2018 - 01.2023
Senior Medical Officer
E-Meditek TPA Private Ltd
10.2016 - 09.2018
Medical Officer
Vidal Healthcare TPA Pvt Ltd
11.2015 - 07.2016
Medical Officer
Mediassist TPA India Pvt Ltd
08.2013 - 11.2015
Bachelor of Science - Dental Surgeon
J.S.S Dental College And Hospital
04.2001 -
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