Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Timeline
Generic

Siraj Ahmad Siddiqui

BHMS
Lucknow

Summary

Review and analyze suspicious and potentially fraudulent insurance claims. Collaborate with claims department and industry anti-fraud organizations to resolve claims. Examine photographs and statements. Interview claimants and witnesses to gather factual information. Consult police and hospital records when needed. Investigate and process health & life insurance claims for policyholders. Verify insurance claims and determine fair amount for settlement. Research claims and incident information to deliver solutions and resolve problems.


Overview

7
7
years of professional experience
8
8
years of post-secondary education
3
3
Certifications

Work History

Claims Investigation

Freelancer
Lucknow
12.2021 - Current

Doctor with over 10 years of experience in claim investigation and research, claims analysis, patient care, physical therapy, and insurance policy review. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements. Consistently saved costs while increasing profits. Enthusiastic and eager to contribute to team success through hard work, attention to detail, and excellent organizational skills. Motivated to learn, grow and excel in the health insurance industry.

Assistant Claims Manager

HDFCERGO
Noida
12.2019 - 08.2021
  • Determined proper course of action for claims processing.
  • Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
  • Documented and communicated timely claims information while supporting accurate outcomes.

Claims Examiner

Authentic Healthcare
Noida
07.2018 - 09.2019

Review and analyze suspicious and potentially fraudulent insurance claims.

Collaborate with claims department and industry anti-fraud organizations to resolve claims.

Examine photographs and statements.

Interview claimants and witnesses to gather factual information.

Consult police and hospital records when needed.

Investigate and process health & life insurance claims for policyholders.

Verify insurance claims and determine fair amount for settlement.

Research claims and incident information to deliver solutions and resolve problems.

Branch Manager

MD India Healthcare TPA
Lucknow
11.2015 - 07.2016

Review and analyze suspicious and potentially fraudulent insurance claims.

Collaborate with claims department and industry anti-fraud organizations to resolve claims.

Examine photographs and statements.

Interview claimants and witnesses to gather factual information.

Consult police and hospital records when needed.

Investigate and process health & life insurance claims for policyholders.

Verify insurance claims and determine fair amount for settlement.

Research claims and incident information to deliver solutions and resolve problems.

Education

BHMS - Homeopathic Medicine

Kendriya Vidhyalaya
Rewa
11.2000 - 08.2008

Skills

Claims Investigation

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Accomplishments

Controlled fraudulent and suspicious claims in blacklisted hospital of central UP.

Recognized the pattern of few blacklisted hospitals to produce fraudulent claims and timely intervention by regular field visits. Blacklisted one of notorious hospital of Lucknow to control fraud.

Apt in use of technology in investigation, use of goggle maps & goggle time line, Social Media and online confirmation of doctors registration.

Controlled fraud by recognizing fraudulent pathology and indoor case paper entries made by non medico background.




Certification

Information Security, Cyber Security and Business Continuity Management System

Timeline

Claims Investigation

Freelancer
12.2021 - Current

Information Security, Cyber Security and Business Continuity Management System

03-2021

Prohibition of Sexual Harassment FY 20-21

03-2021

Anti Money Laundering FY 20-21

03-2021

Assistant Claims Manager

HDFCERGO
12.2019 - 08.2021

Claims Examiner

Authentic Healthcare
07.2018 - 09.2019

Branch Manager

MD India Healthcare TPA
11.2015 - 07.2016

BHMS - Homeopathic Medicine

Kendriya Vidhyalaya
11.2000 - 08.2008
Siraj Ahmad SiddiquiBHMS