Jinal Parikh
Mumbai,MH
Summary
Extensive expertise of 15+ years in assessing medical claims, collecting background information and risk assessments, evaluating statistical data using specialist computer programs. Skilled in evaluating the possibility of losses due to catastrophe or excessive insurance; examining documents to determine the degree of risk. Effective communicator who excels at performing risk assessment, reviewing and evaluating insurance claims and support to clients.
Overview
18
18
years of professional experience
Work History
Consultant
ICICI Prudential Life Insurance Company
02.2013 - Current
- Review of health claims, critical illness claims including indemnity, Rider with adherence to regulatory timeliness as well as Company’s prescribed timelines (T + 1)
- Managing team to process accurate claims and pay out of only valid claims guidance in relation to medical Inputs to the team
- Review of medical records of the patient to validate the claims and determine coverage based on policy terms
- Identifying and addressing fraudulent claims and referring them for risk assessment for thorough investigations and taking appropriate action on the same
- Managed Grievance complaints, Ombudsman complaints
- Monthly Recon for Health Rider claim to make for Audit efficiency
- Monthly reporting to Senior management on claims raised vs processed with reasoning for acceptance or rejections
- Informing the team about any new processes/guidelines to be followed during processing of the claim
- Handling escalations received from various sources (social media, website, IRDAI complaints, email complaints) grievances, and reconsideration requests received for Health and critical illness claims
- Facilitating seamless coordination with stakeholders like Reinsurers, Underwriting team, Legal team, etc
- For opinion and decisions on claims
- Training new team members on approach for processing claims
- BRS and process definition for system efficiency
- UAT testing for Products
- Developed effective improvement plans in alignment with goals and specifications.
- Optimized customer experience by delivering superior services and effectively troubleshooting issues.
Employee
ICICI Prudential Life Insurance Company
05.2007 - 01.2011
- Claims Adjudication
- Health Claims Training
- Claims Data Management
- Third Party Administration and co-ordination
- Claim Escalation
- Medical Underwriting
Education
Bachelor of homeopathic medicine and surgery -
YMT Homoeopathic Medical College Hospital & PG Institute
Skills
- Proficient in MS Office applications
- Team collaborator
- Strong communication skills
- Time management
- Ability to accept new challenges
- Business presentation
- Technical review
- Continuous improvement
- Team leadership & development
- Attention to detail
- Analytical thinking
Languages
English
Advanced (C1)
Hindi
Upper intermediate (B2)
Gujarati
Intermediate (B1)
Marathi
Elementary (A2)
Timeline
Consultant
ICICI Prudential Life Insurance Company
02.2013 - Current
Employee
ICICI Prudential Life Insurance Company
05.2007 - 01.2011
Bachelor of homeopathic medicine and surgery -
YMT Homoeopathic Medical College Hospital & PG Institute
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