Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Work Availability
Quote
Timeline
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ROHINI SAKPAL

Navi Mumbai

Summary

Result oriented professional with medical and administrative skills. Have the ability to work effectively with devotion. Career Objective: To be affiliated with a progressive organization where I can develop and use Medical knowledge and skills to make a substantial contribution and challenge abilities.

Overview

20
20
years of professional experience
1
1
Certification

Work History

General Manager Health Claims

ICS Services Pvt Ltd
01.2020 - Current
  • Quality Check of Reimbursement and cashless claims. Detection of Suspicious/ Fraud detection for various Insurance Companies Pan India. Investigative evidence Analysis into professional report with recommendations. QC of narrative report based on investigation conducted with evidence to support.

Manager Claims

Medicare TPA Services Pvt Ltd
02.2016 - 01.2019
  • Processing Reimbursement and cashless claims.

TPA Manager & Hospital Administration Role

Dr R.N. Patil’s Suraj Hospital
08.2015 - 02.2016
  • TPA Desk: cashless profile.

Assistant Manager

MD India Health Care Services Pvt. Ltd TPA
03.2012 - 07.2015
  • Handling Claims team, Operations, Customer care, Grievances, Audit, Attended meeting with Insurance Company and corporate
  • Handled Separate vertical of HDFC Std Life corporate
  • Coordination in underwriting the corporate policy
  • Handled Investigation and Fraud Detection team of 20 members

Medical officer

Medi- Assist India Private limited
05.2008 - 09.2010
  • Role: Processing Cashless, Re-imbursement, Audit, Also worked for Reliance Corporate at DAKC.

Medical Advisor

Raksha TPA
10.2007 - 04.2008
  • Processing Re-imbursement, corporate, cashless, Pre auth.

Medical Officer

J. Doshi Ghatkopar Hindu Sabha Hospital
11.2006 - 10.2007

Medical Officer

Rajpal Hospital Koparkhairane
06.2004 - 10.2005
  • Rajpal Hospital is providing the services as follows General Medical, Surgical, Maternity, Orthopedic, ECG, X-ray, Pathology Cab and Vaccination Centre
  • Role: Looking after the patients like follow-ups, attending emergency cases
  • Involved in managing indoor and outdoor patients, Reporting to concerned doctor

J.J. Group of Hospital
04.2005 - 08.2005
  • Handled casualty, medical & surgical emergencies, IPD & OPD

Public Health Centre
01.2005 - 04.2005
  • Handled medical & surgical emergencies, IPD & OPD

Sion Ayurved Hospital
06.2004 - 01.2005
  • Managed Surgical & ENT OPD & IPD & Gynaec.

Education

B.A.M.S -

Ayurved Mahavidyalay, Maharashtra University of Health Sciences

PGDHHM -

Symbiosis International University

DSA -

SSC Modern High School Vashi Navi

Skin Aesthetics from Tulip (International Certification) -

Skills

  • Health Insurance claims
  • Cashless claims
  • Reimbursement health claims
  • Health claims - fraud detection
  • Health claims investigation
  • Quality check of health claims
  • Claims review
  • Safety Assurance
  • Process Redesign
  • Staff Training

Accomplishments

  • HSC Modern College Vashi Navi Mumbai Class II March 1999.

Certification

BAMS Govt. Ayurvedic College SION MUMBAI Class I June 2004. PGDHHM Symbiosis International University PUNE Grade A May 2007 DSA Tulip MUMBAI Class I Jan 2011 Personal Information DATE OF BIRTH: November 25th . FATHERS NAME: MR. Dinesh K. Gawane HUSBANDS NAME: MR. Sachin Sakpal PLACE OF BIRTH: Mumbai.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

The way to get started is to quit talking and begin doing.
Walt Disney

Timeline

General Manager Health Claims

ICS Services Pvt Ltd
01.2020 - Current

Manager Claims

Medicare TPA Services Pvt Ltd
02.2016 - 01.2019

TPA Manager & Hospital Administration Role

Dr R.N. Patil’s Suraj Hospital
08.2015 - 02.2016

Assistant Manager

MD India Health Care Services Pvt. Ltd TPA
03.2012 - 07.2015

Medical officer

Medi- Assist India Private limited
05.2008 - 09.2010

Medical Advisor

Raksha TPA
10.2007 - 04.2008

Medical Officer

J. Doshi Ghatkopar Hindu Sabha Hospital
11.2006 - 10.2007

J.J. Group of Hospital
04.2005 - 08.2005

Public Health Centre
01.2005 - 04.2005

Medical Officer

Rajpal Hospital Koparkhairane
06.2004 - 10.2005

Sion Ayurved Hospital
06.2004 - 01.2005

B.A.M.S -

Ayurved Mahavidyalay, Maharashtra University of Health Sciences

PGDHHM -

Symbiosis International University

DSA -

SSC Modern High School Vashi Navi

Skin Aesthetics from Tulip (International Certification) -

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