JAYESH KG
Chennai
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
11
11
years of professional experience
Work History
Lead II BPM
UST International Pvt LTD
Chennai
06.2022 - Current
- Led a team of assemblers, providing guidance and support in their daily tasks and professional development.
- Create an inspiring team environment with an open communication culture.
- Set clear team goals.
- Delegate tasks and set deadlines.
- Oversee day-to-day operation.
- Monitor team performance and report on metrics.
- Motivate team members.
- Discover training needs and provide coaching.
- Listen to team members’ feedback and resolve any issues or conflicts.
- Recognize high performance and reward accomplishments.
- Encourage creativity and risk-taking.
- Suggest and organize team building activities.
- Conducted quality assurance inspections on finished components and identified issues.
Insurance Incharge
PIMS Hospital
03.2022 - 06.2022
- Built strong relationships with patients / Relatives through consistent communication and excellent customer service.
- Resolved complex claims issues, advocating on behalf of clients to ensure fair settlements.
- Mentored juniors, sharing industry insights and best practices for success in the field.
- Maintained accurate records of all transactions, ensuring compliance with Hospital policies and regulatory requirements.
- Designs, updates and implements policies, procedures and protocols to ensure efficiency and accuracy in insurance operations.
- Monitors insurance discounts, rejections and submits periodic reports to the Management for review.
- Ensures that the insurance schemes are up to date on the system.
Senior Executive
Mediassist TPA
Bangalore
11.2015 - 10.2020
- Reduced personnel costs by restructuring the management hierarchy to eliminate redundancies and promote cross-functional collaboration.
- Had to handle claims processing in Bangalore for major corporate Companies like Infosys, TCS, Emphasis, NTT Data.
- Verify the physical papers whether they are submitted in respect of the person / ID as per the claim received in the application.
Online process Checking whether the treatment has been availed as an inpatient or not. - Check whether the claim fall under pre or post hospitalization claim. if so, link it up with the main claim.
- Check whether the hospital meets the definition of the hospital /nursing home.
- Check whether the hospitalization is for minimum 24 hrs or not.
- Check whether the claim is under fresh policy or under a renewed policy.
- Check whether the documents submitted are original or photocopies and deduction of non-medicals.
- Check whether the other policy exclusions are operating.
- Check for the reimbursement claim whether the claim form & certificate from the treating doctor have been submitted along with the discharge summary.
- Check whether the medicines purchased from outside pharmacy have supporting prescriptions.
- Check whether the medicines are relevant to the ailment.
- Check whether the diagnostic tests are relevant or not & that proper reports with necessary bills are available in the file.
- If the claim is respect to a road accident involving automobiles or cases recorded as medico-legal cases by the hospitals, to process the claim only after obtaining the police FIR & satisfying that it was not an attempted suicide, the person injured had not been under the influence of intoxicating liquor or drugs.
- Complete processing - approving/denial (Pre-authorization, cashless, reimbursement claims).
- Raising query for the additional documents required to the hospitals & to the claimant.
- Moving claims to investigation in case of fraud claims, inflated bills &Maintain quantity & quality within TAT.
- Team management
- Negotiated favorable contract terms with vendors, leading to significant cost savings while maintaining product quality and timely production.
Staff Nurse
Fortis Hospital
Bangalore
05.2014 - 08.2015
- Evaluate and monitor the patient’s progress.
- Identify sudden or subtle changes in a patient’s medical condition.
- Deliver regular updates to doctors, patients, and their family members.
- Begin treatment and monitor doses.
- If necessary, respond to a medical emergency and alert the appropriate doctors.
- Care for patient needs throughout their recovery in the ICU unit.
- Complete all necessary paperwork before transferring a patient.
- Maintain patient records.
- Create and implement effective care plans.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
Staff Nurse
Sparsh Hospital
Bangalore
12.2012 - 03.2014
- Administer nursing care to ill, injured, or disabled patients
- Diagnose and establish patient treatment plans
- Monitor and report changes in patient symptoms or behavior
- Communicate with collaborating physicians or specialists regarding patient care
- Educate patients about health maintenance and disease prevention
- Facilitate referrals to other healthcare professionals and medical facilities
- Maintain accurate patient medical records
- Provide advice and emotional support to patients and their family members
Education
Bachelor of Science - Nursing
M V M Suma Institute of Nursing Sciences
BangaloreHSE - Science Education
G H S Sreepuram, HSE Board Kerala
ManakkadavuS.S.L.C. -
G H S Karthikapuram, State Board of Public Examination Kerala
03.2004
Skills
- Web Services
- Business Analysis
- Database Management
- Integration Expertise
- Problem-Solving
- Customer Relations
- Task Prioritization
- Relationship Building
- Organization and Time Management
- Verbal Communication
- Team building
Sex
Male
Marital Status
Married
Religion
Hindu
Contact Mobile No
07338335444
Registration
KARNATAKA STATE NURSINGCOUNCIL.BANGALORE, 45007
Personal Information
- Date of Birth: 04/30/88
- Nationality: Indian
References
- Mrs.Jemimal Christopher, Nurse Manager, Sparsh Hospital, Bangalore, 08861200102
- Mrs. Judy Justin, Medical ICU Incharge, Fortis Hospital, Bangalore, 09945497704
- Mr. BS Patil, Team leader, Mediassist TPA Pvt.Ltd, Bangalore, 09986702900
- Mr.Balachandran, Administrative Officer , PIMS Hospital , Walayar , Palakkad 09447295265
Disclaimer
I, Jayesh K.G hereby submit this curriculum vitae for your kind consideration and favorable orders. I assure you, that if I am selected I will discharge my duties to the entire satisfaction of my superiors. I declare that the information furnished above is true to the best of my knowledge.
Languages
Malayalam
Bilingual or Proficient (C2)
English
Bilingual or Proficient (C2)
Tamil
Bilingual or Proficient (C2)
Hindi
Advanced (C1)
Kannada
Advanced (C1)
Telugu
Elementary (A2)
Timeline
Lead II BPM
UST International Pvt LTD
06.2022 - Current
Insurance Incharge
PIMS Hospital
03.2022 - 06.2022
Senior Executive
Mediassist TPA
11.2015 - 10.2020
Staff Nurse
Fortis Hospital
05.2014 - 08.2015
Staff Nurse
Sparsh Hospital
12.2012 - 03.2014
Bachelor of Science - Nursing
M V M Suma Institute of Nursing Sciences
HSE - Science Education
G H S Sreepuram, HSE Board Kerala
S.S.L.C. -
G H S Karthikapuram, State Board of Public Examination Kerala