Accomplished management professional adept at building high-performing teams. Proven ability to drive cross-functional collaboration and implement innovative solutions to complex business challenges. Committed to delivering results that exceed expectations while maintaining a focus on continuous improvement and sustainable growth.
Handled corporate insurance products such as Standard Fire and Special Peril Policy, including loss of profit, Engineering, and loss of profit.
Monitored key business risks and established risk management procedures.
Manage the day-to-day administration of employee benefits, including enrolments and Training, compliance testing, processing monthly invoices
Prepare and monitor budgets including manpower and automation budgets
Partner with Insurance vendors and TPAs to prepare reports and applications
Developing written materials (e.g. forms, procedures, brochures, etc.) to document benefits activities, providing written reference and/or conveying information
Led recruitment and development of strategic alliances to maximize utilization of existing talent and capabilities.
Miscellaneous Insurance,
Holds the credit for rating complex risks of large projects. Managed automation and advanced reporting of insurance data Operations, Risk Management and claim management, and Underwriting
.
Regulatory Knowledge:
Policy Implementation: Developing and implementing policies that align with regulatory requirements. Compliance Audits: Regularly conduct internal audits to ensure compliance with all legal and regulatory standards.
Claims Management
Claims Processing: Overseeing the accurate and timely processing of claims, including adjudication, payment,
Fraud Detection: Implementing systems to detect and prevent fraudulent claims.
Customer Service: Ensuring claimants receive clear communication and assistance throughout the claims process.
Provider Network Management
Contract Negotiations: Negotiating contracts with healthcare providers, ensuring competitive pricing, and managing relationships.
Network Adequacy: Ensuring the insurance plan provides adequate access to healthcare services for policyholders.
Quality Assurance: Monitoring the quality of care provided by network providers and addressing any issues.
Underwriting and Risk Management
Risk Assessment: Evaluating the risk associated with insuring individuals or groups and setting appropriate premium rates.
Premium Pricing: Developing pricing models that balance competitiveness with profitability.
Reinsurance: Managing reinsurance contracts to mitigate the risk of large claims.
Customer Relationship Management
Enrolment Services: Managing the process of enrolling individuals and groups into health insurance plans. Member Education: Providing resources and education to help members understand their benefits and how to use them.
Issue Resolution: Handling member inquiries, complaints, and appeals efficiently.
Financial Management
Budgeting and Forecasting: Creating financial plans that ensure the long-term sustainability of the insurance plan.
Financial Reporting: Regularly reporting financial performance to stakeholders.
Cost Control: Identifying and implementing cost-saving measures without compromising service quality.
Technology and Data Management
Health Information Systems: Utilizing advanced software and systems for claims processing, data management, and reporting.
Data Security: Ensuring the confidentiality and security of sensitive member information.
Analytics: Leveraging data analytics to improve decision-making, identify trends, and optimize operations.
Strategic Planning and Development
Market Analysis: Conducting market research to identify trends, competitive positioning, and opportunities regulatory changes.
Business Growth: Developing strategies for customer acquisition, retention, and overall business expansion for new products
Title: Principal Business Analyst(Group Health Insurance) Operation, Marketing, and Claims
Insurance Management
Top of Form
Insurance Knowledge: A deep understanding of insurance principles, policies, and terminology specific to automobiles. This includes knowing different types of add-on coverages.
Risk Assessment: The ability to assess the risk associated with insuring different types of vehicles. This involves evaluating factors such as driving records, vehicle make and model, location, and usage patterns.
Customer Service: Excellent customer service skills are vital for interacting with policyholders, answering their questions, addressing concerns, and guiding them through the claims process.
1. Communication Skills: Possess Clear and effective communication to explain policy terms, coverage options, claims procedures, and any legal requirements to policyholders. Being able to communicate complex concepts understandably is crucial.
2. Data Analysis:Analyzing data related to claims, premiums, and customer demographics can help in identifying trends, making informed decisions, and improving the efficiency of insurance operations.
3. Claims Handling:Managing claims efficiently is a critical aspect of insurance management. This involves processing claims accurately, verifying information, assessing damages, and determining the appropriate coverage.
4. Negotiation Skills: When dealing with claims, negotiation skills are necessary to ensure fair settlements for all parties involved while staying within the bounds of policy terms.
5. Legal and Regulatory Compliance: Staying updated on relevant laws and regulations related to insurance is essential to ensure compliance and avoid legal issues.
6. Problem-Solving:Insurance managers often encounter complex situations that require quick and effective problem-solving. This could involve resolving disputes, addressing coverage gaps, or handling unusual claims scenarios.
7. Attention to Detail: Precise attention to detail is crucial for accurately documenting policies, claims, and other crucial information. Mistakes can lead to misunderstandings, delays, and potential legal issues.
8. Time Management: As Insurance managers often have to handle multiple tasks simultaneously, from policy issuance to claims processing. Good time management helps ensure that tasks are completed efficiently, and deadlines are met.
9. Technology Proficiency:Familiarity with insurance management software, databases, and other technology tools can streamline processes and improve overall efficiency.
10. Ethical Decision-Making: As insurance managers often deal with sensitive financial matters and personal information. Ethical decision-making is vital to maintain trust and integrity within the industry.
11. Team Management: In larger insurance firms, management skills are needed to oversee teams of underwriters, claims adjusters, and customer service representatives.
12. Continuous Learning: The insurance industry is dynamic, with evolving regulations, technologies, and market trends. Being open to continuous learning and adapting to change is essential for long-term success.
Advanced Knowledge of Microsoft tools and spreadsheets, File Management, online security, and website troubleshooting digital skills basic graphic editing and cloud service, HTML, and coding SQL
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