Medha Madhup
Delhi
Summary
Motivated Deputy Manager with 4 years of experience juggling multiple priorities to keep company running smoothly. Communicative team leader possessing outstanding time management and documentation abilities. Polished in overseeing employee performance and guiding and motivating new talent.
Overview
4
4
years of professional experience
Work History
Deputy Manager
HDFC ERGO GENERAL INSURANCE COMPANY PRIVATE LIMITED.
NOIDA
10.2021 - Current
- Managed a team of 30 claims adjusters, ensuring that all customer inquiries were responded to in a timely manner.
- Reviewed and approved complex claim settlements, making sure they were within policy guidelines.
- Monitored the performance of adjusters to ensure accuracy, timeliness and compliance with departmental standards.
- Provided training and guidance on best practices for handling new and existing claims.
- Developed procedures to streamline the claims process, improving overall efficiency.
- Analyzed data from previous claims to identify trends and areas for improvement.
- Resolved escalated customer issues by providing effective solutions in a timely manner.
- Identified potential fraud cases by conducting investigations into suspicious activity.
- Prepared detailed reports on claim status and activities for management review.
- Ensured compliance with all applicable laws, regulations, policies and procedures related to claims processing.
- Collaborated with other departments to investigate potential coverage disputes or discrepancies.
- Negotiated settlement agreements between claimants and insurance companies when necessary.
- Created processes for tracking open cases, monitoring progress towards resolution goals.
- Maintained accurate records of all claim activities including payments, denials and appeals.
- Conducted regular audits of the department's performance metrics to ensure accuracy.
- Trained new team members on policies and procedures for claims handling.
- Provided technical support to staff members regarding system upgrades or changes in procedure.
- Managed team members effectively to meet high production standards with accurate results.
- Motivated team members to maintain targeted turnaround time to obtain processing goals.
- Submitted clean claims to reduce denial rates, following payer reimbursement policies and procedures.
- Conducted meetings to discuss issues and find pertinent solution.
Senior Medical Officer
Safeway TPA
01.2021 - 08.2021
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
- Adhered to all applicable laws, regulations, and company standards while processing claims.
- Researched discrepancies between submitted documentation and actual records to identify errors or omissions.
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
Medical Officer
eExpedise Healthcare Private Limited
Gurugram
11.2019 - 09.2020
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
- Performed data entry into the computer system to record information regarding claim status.
- Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.
- Analyzed customer complaints, identified root causes of problems, and developed corrective action plans.
- Assisted in emergency situations by providing life-saving measures when necessary.
- Adhered to all safety protocols while performing medical procedures.
Education
Bachelor of Science - Bachelor of Dental Surgery
VINOBA BHAVE UNIVERSITY
HAZARIBAG 09-2017
Skills
- Health claim Processing & Auditing
- Initial & Final Settlement
- Hospital Empanellement
- Task Delegation
- Cost Analysis and Savings
- Operations Management
- Employee Performance Evaluations
- Employee Scheduling
- Recruiting and Interviewing
- Product and Service Knowledge
- Promotional Planning
- Team Motivation
- Workload Management
- Employee Engagement
Languages
Hindi
First Language
English
Advanced (C1)
C1
Timeline
Deputy Manager
HDFC ERGO GENERAL INSURANCE COMPANY PRIVATE LIMITED.
10.2021 - Current
Senior Medical Officer
Safeway TPA
01.2021 - 08.2021
Medical Officer
eExpedise Healthcare Private Limited
11.2019 - 09.2020
Bachelor of Science - Bachelor of Dental Surgery
VINOBA BHAVE UNIVERSITY
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