Medical Life Insurance

Puja Solanki

Pune

Mob. No.: 902-***-****

ac37ne@r.postjobfree.com

Professional Summary

A highly motivated Medical professional with a Doctor’s degree, Post Graduate diploma in emergency medical services, and MBA in Hospital and Health care Management. Comes with 8.5 years of overall work experience with an excellent track record as a Research Analyst, Life APS summary underwriter, Senior Executive, Clinical Observer, Medical adviser and Medical reviewer – along with high expertise in client engagement, relationship management, team management, problem solving and performance management skills.

WORK PROFILE-

Research Analyst.

Duration: Started working from May 2017, It has been 6 months.

Company: Cotiviti India PVT LTD (formerly Connolly ihealth technologies)

Client: Blue Cross Blue Shield, UnitedHealth Group, Molina Healthcare, Aetna Inc, Humana, Gateway, Amerigroup, WellCare Health Plans Inc.

Description: Research Analyst – Operations.

oSupport US Research MD’s and CPM’s to provide oversight for the accuracy and quality of research materials originated from medical policy and client services.

oSupport the scheduled review process for global and specialty policies in collaboration with the US Research MD’s.

oSupport the scheduled review process for State Medicaid policies in collaboration with the US Client Medical Directors and/or Client Policy Managers.

oCoordinate with US Research Medical Directors to manage the integrity of the Payment

oPolicy Library and ensure the Payment Policy Library is accurate and up-to-date.

oSupport quarterly and annual updates in collaboration with the US Research Medical Directors.

oEnsures changes to rule sets are accurate, complete and are finished in a timely manner including documentation of notable changes.

oResponds to the research related queries pertaining to the medical policy raised by internal personnel or client including but not limited to:

Questions about claims edits that enforce medical policy.

Interpretation of how claims edits relate to policy statements.

Recommendations regarding modifications of edits.

oConduct research to explore potential opportunities to expand the current medical policy set.

oPartner well with global research team members to advance the Research agenda.

oEducate US Client Service MDs and Client Policy Managers (CPMs) on new changes and policy updates by actively participating in monthly meetings.

APS summary underwriter for AAA Life insurance.

Duration: April 2016 to September 2016

Company: IBU insurance, Hartford.

Description: Reviewing and summarizing medical data/APS of AAA life insurance, making a precise summary.

Providing AAA underwriters with MIB coding and case summary for that particular case.

Senior Process associate/ Medical Reviewer

Duration: Jan 2011 to Nov 2015

Company: Principal Global Services, Pune

Principal Global Services is a wholly owned subsidiary of Principal Financial Group, a global leader in offering businesses to individuals and institutional clients a wide range of financial products and services including retirement and investment services, life and health insurance and banking.

Job description:

oReviewing and summarizing policy applicant’s medical information such as attending physician’s statements (APSs), lab reports, paramedical exams and/or other related underwriting information consistent with PFG's (Principal Financial Group) standards.

oProviding clear, brief & easy to read case documentation/ summary for the Underwriters which help them in taking underwriting decisions.

oLeading various projects like quick quote underwriting, Triage underwriting with/ without use of Swiss-Re, accelerated underwriting & also performing as a part of the team in each of these projects.

oSolving all the process & projects related queries of my peers.

oHandling the responsibility of assigning activities, cases (work) to the entire team.

oAssisting my leaders in preparation of various performance reports monthly, quarterly and annual reports with presentations in quarterly open house & annual town hall of the team.

oAlong with this responsibilities, based on my excellent performance in my work, I was selected to work on multiple Information Technology department projects related to life insurance listed below:

oAffiliate Project.

oClient Consolidation project.

oPredictive Analysis.

Previous Work Experience:-

oWorked as CMO at Dehu road Trauma Centre for Lokmanya Hospital, Nigdi for 8 months.

oWorked as an Observer at Kartik Ped Hospital, Nigdi for 4 months.

oWorked as an observer at DR.Tathed’s Homoeopathic clinic in Chinchwad for 6 months.

oWorked as Medical Advisor in MD India Healthcare TPA in Authorisation dept. for 4 months.

oIn MD India completed 1 month of training, then was placed in Authorisation dept. as a MA used to issue AL, DAL or Query to the empanelled hospitals or insurance company.

Achievements:

oBased on my quality & performance of work, I have achieved highest approval limit of 10 Million (which is the highest & last approval limit in my organisation) to work on insurance applications with face amounts of 10 million and more.

oHaving a sound knowledge of Swiss-Re & using it on day to day basis.

oPursued Agile basic training in June 2015.

oPursuing ALMI currently & already passed LOMA 280, LOMA 290 with distinctions in each exam.

oAwarded with a performance award - “Best Quality performance of the Q4-2014 with 100% quality throughout the quarter with 0 error”.

oAwarded with an excellence award - ‘’Excellent Performance in Affiliate and Consolidation Projects in December 2014’ – this award was for my excellence performance in these projects and for my collaboration with IT person to utilise software skills to deliver this project 1.5 months earlier than its expected date of deliver.

oAwarded with a performance award- “Best Quality performance of Quarter 2, 2012 with 100% quality throughout the quarter with 0 error”

oAwarded with a performance award- “Best Quality performance of Quarter 4, 2012 with 100% quality throughout the quarter with 0 error”

Technical Skills:

oExpert level medical reviewer, expertise in documentation and summarizing

oVery good hands on Windows and MS-Office suite with Word, PowerPoint, Excel

oExperience in working over remote applications based on Citrix/ VDI.

Certifications:

oLOMA 280- Principles of insurance from LOMA (Life Office Management Association) University with Distinction.

oLOMA 290- Insurance company operations from LOMA (Life Office Management Association) University with Distinction.

Educational Qualifications:

oMBA in Hospital and Health care Management from DY Patil College Pimpri with distinction.

oPGDEMS (Post Graduate diploma in emergency medical services) from Nashik University) From Ruby Hall Clinic, Pune In Partnership With West Midlands Ambulance Service England.

oBHMS- Lokmanya Homoeopathic Medical College, Pune, 2008 -- 65%.

Academic Achievements:

oSecured Third Rank in SSC (83%).

oSecured First Rank in First Year BHMS.

oSecured Highest Marks in Pharmacy.

oSecured First Rank in Third Year BHMS.

oSecured Highest Marks in Gynac & Obs.

oSecured Second Rank in Final Year BHMS.

oAwarded as BEST STUDENT Of College in Final Year.

oParticipant in Scientific Seminar -2004

Personal Details:

Date of birth : 15 November 1985

Marital status : Single

Nationality : Indian

Gender : Female

Contact Number : 902-***-****

Email ID : ac37ne@r.postjobfree.com

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