GIRISH KUMAR
Jaipur
Summary
Experienced leader with a strong background in insurance claims and risk-based audits. Adept at guiding teams, managing complex projects, and achieving strategic objectives. Demonstrates exceptional skill in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Recognized for a collaborative approach and unwavering commitment to excellence.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Advisor / Consultant (Freelancer)
Financial Spikes
01.2022 - Current
- Provide financial planning and Insurance advisory support to clients
- Support investment professionals to cultivate client relationships
- Review and Present Health Insurance portfolio as per requirement
- Respond to prospective customer queries about Insurance related and Audit related queries
- Assist in the development plans for the company
- Offer subject matter expertise to fellow Advisors
Assistant Manager - Medical Claims Processing
Mednet (Munich Re Associated Company)
10.2013 - 01.2021
- Supervising a team of claims processors and supervising all function of claims including receiving of claims, Auditing and final settlement
- Reporting to Senior Management (GM) about MIS , Actuarial reports, Operational reports etc.
- Assisting Management in framing and establishing company policies as per business guidelines.
- Assisting other departments including Medical approvals, IT & Production and Network departments in their day-to-day required activities
- Supervising all new claims recruitments in terms of Induction, training and on board activities.
- Handling performance related issues of team members through analyzing data
- Handling and supervising various claims Projects such as Digitisation, Cost Containment from local and regional office of Munich Re.
Internal auditor -Risk Consulting and Advisory
KPMG
04.2012 - 09.2013
- Experience in conducting risk assessment of assigned department or functional area in established/required timeline.
- Performed auditing and risk assessments in various sectors such as Insurance, FMCG, Retail, Civil Aviation, and Hospitality Industry, Government departments
- Prepare and Establish risk-based audit programs related to audit functional area.
- Responsible to ensure that there is effective Document control Function within all the related processes
- Determine compliance with policies and procedures.
- Finalizing reports with Audit Partner and presenting to Client Board Committee .
Team Leader in Health Insurance Claims
GEMS TPA
06.2009 - 04.2012
- Allocating the processing targets to the respective associates; maintaining the monthly and yearly reports about claims production.
- Reporting the monthly MIS to higher management.
- Participating in operational and Quality reviews such as Provider Management, Provider negotiations, Member updating, policy reviews, Quality assurance and Training etc
- Assisting IT team in updating new functions in the Claims software
Process Developer – Claims Processing
Genpact India
04.2006 - 05.2009
- Handling Process Development related to international claims for over 130 countries (Saudi Arabia, Bahrain, Qatar, Greece, China, UAE, France, Germany, Switzerland, UK, Denmark, etc.) with different languages as German, French, Swiss, Spanish, Arabic, etc
- Conducting the quality auditing for both Genpact as well as BUPA, UK.
- Assisting Staff in medical terminology trainings and day medical coding related issues
- Reporting to Client and Company management about the quality and performance of claims staff
- Assisting UK personal claims, corporate claims and International claims team members in Medical Guidelines and ICD trainings
- Responsible for communicating client on weekly basis about claims quality audits and SLA targets
Education
Licentiate In Insurance -
Insurance Institute Of India
12.2022
Executive Programme in General Management - Quality Audit (Insurance Claims)
IIM Calcutta
12.2009
Master of Science - Bioinformatics (Speciliased in Drug Desigining)
Sikkim Manipal University (Deemed)
Manipal, Karnataka08.2006
Diploma in Pharmacy -
Maharshi Arvind College of Pharmacy
Jaipur, Rajasthan12.2003
Bachelor of Science - Cell Biology And Anatomy
MDS, University, Ajmer
Ajmer, India06.2001
Skills
- Strategic Planning
- Training and mentoring
- Presentations and public speaking
- Data Interpretation
- Client Engagement
- Analytical Thinking
- Multitasking
Certification
- Certified in Digital Business Transformation Management, CXO Transform
- Certified Governance Risk and Compliance Professional, GRCP, GRCA
- Certified Blockchain Expert V2
- Lean Ace, Genpact India and BUPA healthcare, UK
- IRCA certified Lead Auditor for ISO 9001:2008
- Six Sigma Green Belt Trained
Accomplishments
- Awarded two times as Best Idea awards in Mednet Innovation Program-2016-17
- Awarded for Implementing ISO 9001:2008 QMS in GEMS, 2010
- Awarded as Employee of the Month in April and June 2010
- Silver Award winner for the 'Best Lean Idea' in Genpact Insurance Process- Oct 2007
- 2 times 'Best Of Best Lean' winner in whole Insurance process in Genpact – Dec 2007
- Star Award in Genpact for best performance for Year 2006-2007
- Bronze Award in Genpact for Best Quality and Production for year-2006
Personal Information
- Date of Birth: 04/10/80
- Marital Status: Married
Languages
English
Hindi
Trainingscompleted
- Licentiate in Insurance, Insurance Institute of India, 2022
- Certificate in Healthcare Underwriting, Insurance Institute Of India, 2022
- Advanced Claims, BIBF, 08/20
- Blockchain Technology and its Applications
- Governance, Risk and Compliance, OCEG
- Trained in Six Sigma Green Belt, RAB-QSA
- LEAN Trained
- Train the Trainer
- IRCA (U.K) ISO 9001:2008 Trained Auditor, Indian Institute of Quality Management System-India
- Anti Money Laundering, Munich Re
- Innovations and Project Management, BIBF Bahrain
- Business Reviews & On Job Trainings
Timeline
Advisor / Consultant (Freelancer)
Financial Spikes
01.2022 - Current
Assistant Manager - Medical Claims Processing
Mednet (Munich Re Associated Company)
10.2013 - 01.2021
Internal auditor -Risk Consulting and Advisory
KPMG
04.2012 - 09.2013
Team Leader in Health Insurance Claims
GEMS TPA
06.2009 - 04.2012
Process Developer – Claims Processing
Genpact India
04.2006 - 05.2009
Executive Programme in General Management - Quality Audit (Insurance Claims)
IIM Calcutta
Diploma in Pharmacy -
Maharshi Arvind College of Pharmacy
Licentiate In Insurance -
Insurance Institute Of India
Master of Science - Bioinformatics (Speciliased in Drug Desigining)
Sikkim Manipal University (Deemed)
Bachelor of Science - Cell Biology And Anatomy
MDS, University, Ajmer
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