Summary
Overview
Work History
Education
Skills
Timeline
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SAURAV TOMAR

SAURAV TOMAR

Insurance Manager
Gurgaon

Summary

Insightful Manager with experience directing and improving operations through effective employee motivational strategies and strong policy enforcement. Proficient in best practices, market trends and regulatory requirements of industry operations. Talented leader with analytical approach to business planning and day-to-day problem-solving.

Overview

6
6
years of professional experience
5
5
years of post-secondary education
1
1
Language

Work History

Insurance Manager

Pharmeasy surgicare
Gurgaon
01.2022 - Current
  • Manage operations and productivity at an insurance company
  • Accomplished multiple tasks within established timeframes.
  • Cross-trained existing employees to maximize team agility and performance.
  • Create and modify procedures and documents related to policies
  • Assist in claims management
  • Identify and analyse risks associated with policies
  • Achieve target budgets
  • Minimize risk of financial loss
  • Obtain and oversee company insurance or related funds that management uses to cover costs such as disability benefits or lawsuits
  • Direct information for claimants
  • Preside over claims investigations
  • Review insurance policies
  • Manage insurance data for reports
  • Analyse statistical data, such as mortality, accident, sickness, disability, and retirement rates and construct probability tables to forecast risk and liability for payment of future benefits
  • Determine premium rates
  • Ascertain cash reserves necessary to ensure payment of future benefits.
  • Prepared internal and regulatory financial reports, balance sheets and income statements.
  • Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.

Senior Insurance Associate

Pristyn care
Gurgaon
12.2020 - 01.2022
  • Handling all escalations for general insurance and medical claims processing as per TAT
  • Ensuring quick settlement of claims through efficient handling of claims
  • Checking health insurance policy T&C and updating the same in the system and sharing feedback to employees
  • Handling employees queries and helping to assist with network hospital packages tariff
  • Coordinate with hospitals related to MOU and package tariff
  • Planning and scheduling of help desk for efficient handling of client queries pertaining to services/discrepancies/ pending matters to ensure satisfaction with services provided
  • Coordination with TPA/ Insurance co/Brokers and client (HR) for outstanding claims
  • Prepare and present reports on collection activities and progress
  • Check the Admission Request Note before faxing it to TPA for Duration of illness, any past history, the current diagnosis, and all prescription papers, etc
  • For all medical queries get the reply from the treating doctor
  • At the time of discharge before sending the final bill with discharge summary check the pre-auth, approval letter, bill & discharge summary
  • Maintain a relationship with TPA pre-auth department doctors
  • For all medical things, the communication has to be sent by the Doctor to the patient
  • All rejection of cashless has to be communicated to the Patient
  • Ensure No rejection of cases once we have got the final approval from TPA
  • Achieve heightened levels of customer service
  • Take part in the selecting, orienting, training, counseling, and disciplining of employees, Maintain rapport with consultants, patients
  • Inspire team members, and instill enthusiasm and drive
  • Encourage team members to reach targets and enhance productivity
  • Payment recovery from rejected cases
  • Coordinating with team hurdles and providing solutions for the same
  • Handling grievances
  • Ability to perform audits on patient admission , files, and reports.
  • Act as a bridge between medical administration ( doctor, nursing staff, international patient services ) and the patient

Patient Care Executive

venkateshwar hospital
Gurgaon
08.2019 - 12.2020
  • Consulted with supervisors to assess cases and plan strategies for enhancing care
  • Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients
  • Maintained detailed records in compliance with agency standards and regulations
  • Developed and implemented individualized care plans and coordinated necessary services to avail quality care for clients

Front Office Executive

Sri Balaji Action Medical Institute
Gurgaon
06.2017 - 07.2019
  • Received inquiries from corporate customers, major vendors and trade press and delivered informed responses with minimal input from executives
  • Coordinated office activities and operations, secured compliance to hospital policies and welcomed, screened and routed guests
  • Managed filing system, entered data and completed other clerical tasks
  • Documented, published and updated administrative and executive procedures and practices and established internal communication processes

Education

MBA - Hospital management

Swami Vivekanand Subharti University
Meerut
04.2018 - 01.2020

Bachelor of Arts - History

CCS University
Meerut
04.2013 - 04.2016

Skills

Knowledge of Software Applications in Computers

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Timeline

Insurance Manager

Pharmeasy surgicare
01.2022 - Current

Senior Insurance Associate

Pristyn care
12.2020 - 01.2022

Patient Care Executive

venkateshwar hospital
08.2019 - 12.2020

MBA - Hospital management

Swami Vivekanand Subharti University
04.2018 - 01.2020

Front Office Executive

Sri Balaji Action Medical Institute
06.2017 - 07.2019

Bachelor of Arts - History

CCS University
04.2013 - 04.2016

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SAURAV TOMARInsurance Manager