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Medical Manager

Dubai, Dubai, United Arab Emirates
June 11, 2019

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MBBS (India), ECFMG (USA), Analytics (USA), Licentiate (III), MBA (UK)

Present Mailing Address

B2/604 Hariganga Society,

Yerwada, Pune 411006, India

Phone: +91-992*******

Permanent Mailing Address

174 Renuka Flats, Shivaji Nagar Dharampeth,

Nagpur 440010, India

Phone: +91-712*******


IELTS (International English Language Testing System) 2012 USMLE (United States Medico Legal Exams) 2009

GRE (Graduate Record examination) 2006

TOEFL (Test of English as Foreign Language) 2006

Licensure and Certification

L.I.I.I. – Licentiate from Insurance Institute of India (March 2019) HIMSS Healthcare Data Analytics (USA) 2018

Medical License India, 2016

BLS/ ACLS Certificate – Basic/Advanced Cardiac Life Support (American Heart Association) 2016 Professional Diploma in Diabetes Management (PDDM) India, 2015 Educational Commission for Foreign Medical Graduates Certificate (ECFMG) USA, 2008 Medical Education

2015 - Professional Diploma in Diabetes Management (PDDM) - India 2005 - Bachelor of Medicine, Bachelor of Surgery MBBS (Honors) - India Post Graduate Education

2012 -13 International Healthcare Management MBA (Honors) - University of Aberdeen, Scotland, UK

Membership and Honorary/Professional Societies

Life member - Insurance Institute of India

Member of - Indian Medical Association IMA, Delhi Medical Council DMC, Maharashtra MMC Educational Commission for Foreign Medical Graduates ECFMG Certification Philadelphia, USA Honors / Awards

Double Honor Awards in Otolaryngology and Ophthalmology, India, 2005 Commendation Honors in International Healthcare Management, UK, 2013 Work Experiences

05/ 2018 – present BAJAJ ALLIANZ GENERAL INSURANCE, Pune, India ILM Manager – Health, Travel, PA, WC Portfolio (Management Activity)

Reporting to Senior VP, AVP Investigation and Loss Mitigation

Responsible for heading up all investigations dealing with insurance fraud in Health, Travel and Personal Accidents along with Workmen’s Compensation.

Targeted 60 Cr INR savings in a year

Managing a team of 20+ doctors, multiple vendors and investigators across India Knowledge and Skills -

Profound knowledge of various claim standards of insurance products, policies

Developed a strong understanding of insurance policies and legal issues through completion of a series of Insurance Institute of India certification

In depth experience with fraud/abuse detection and claims data analysis

Modified Health Triggers and standardized investigations

Refined New Software development

Finalized claims approval or repudiation decisions with extent of company’s liability

Uncovered fraudulent claims scheme, provided evidence leading to the recovery

Performed audits of private and public healthcare organizations

Managed Internal and External Grievances & Escalations

Conducted Filed Investigation and Recovery

TAT and Target focused team achievement

Recruited and managed doctors and investigators

Review and Reports -

Developed monthly reports on progress of investigations, TAT and Target Achievement

Monitored Ethical & Professional standards to check discrepancy happening to client

Highest level of Medical reviews

Monitoring Industry Alerts

Filed the results with the GIC Data base.

Created presentations for management on reoccurring Fraud trends and new schemes 03/2017 – 05/ 2018 INDUS HEALTH PLUS, Pune, India

Business Development Senior Manager- Insurance and Empanelment (Management Activity)

Worked in a Health care company at a position to devolve an generate new avenues of businesses

Extensive traveling with up to 20 days a month to conduct variety of client and center visits and Grievance management

Insurance Product Development

Developed Pre policy, annual health and pre employment check ups

Attended FICCI Conferences and Networking Events

Working on the Insurance Portfolio and generating consistent stream of revenues in a billion dollar industry

Client center coordination and resolving the conflict and common interests

Empanelment Center tie ups

Conducting sessions of CPR First Air for the first time in Indus

Developed new avenue to generate medical tourism 08/2015 – 07/2016 ALEMBIC PHARMACEUTICALS, India

Strategy Manager- International Business- Special Projects (Management Activity)

• Responsible for techno-commercial evaluation of new drug delivery system

• Developed medical and business rationale for drug development

• Provided strategic planning and direction for clinical development

• Reviewed clinical studies and assessed business deal – covered medical and business aspects

• Developed strategic alliances & partnerships, participated in professional conferences

• Negotiated contracts and partnership deals

02/2014- 07/2015 BOMBAY HOSPITAL, India

Medicine Resident Doctor (Clinical Activity)

• Learnt the management of cardiac emergencies

• Actively participated in the Epilepsy foundation - initiative by National Medical Health scheme 09/2012 - 09/2013 UNIVERSITY OF ABERDEEN, United Kingdom MBA International Healthcare Management, David Newlands (Management Activity)

• Undertook MBA with honors, specializing in International Healthcare Management

• Wrote final case study on Socioeconomic Inequalities in Mental Health management

• Work shadowing with operations manager Aberdeen Royal Infirmary hospital 06/2011 - 08/2012 STEINER MIAMI PLASTIC SURGERY, Florida, USA MediSpa Aesthetic Cruise Physician, Brad Herman, MD (Management Activity)

• Responsible for providing non-surgical cosmetic facial treatments according to patient needs

• Appeared on TV interviews for the promotional purpose •Achieved monthly targets of generating $60,000 monthly revenue • Surpassed monthly targets for more than 70 % of the contract period, rated as the top revenue generator • Managed team of 30 spa therapists to improve medispa services

06/2010 - 03/2011 DUKE UNIVERSITY MEDICAL CENTER, North Carolina, USA Clinical Research Associate, Ashwin Patkar (Research Activity)

• Successfully implemented Phase 3 Clinical Trials • Research included Suboxone trial for the Opioid Dependence and many more •Prepared regulatory documents for IRB • Screened research subjects • Interviewed patients and performed Informed consent • Updated Medical monitors about study • Counseled patient on drug use 10/2009 - 05/2010 ROSS UNIVERSITY SCHOOL OF MEDICINE, Dominica Faculty ICM Dept -Intro to Clinical Medicine, Phillip Cools (Teaching Activity)

• Taught clinical medicine to help student get grasp of practical world • Helped in shaping up the creative and critical thinking of med students through PBL

• Popularity of my practical labs made students to enroll more classes with me 07/2009 - 10/2009 NATIONAL INSTITUTE OF MENTAL HEALTH & NEUROSCIENCE, India Psychiatry Resident Doctor, S K Chaturvedi (Clinical Activity) 11/ 2008 - 02/2009 NORTH TEXAS STATE HOSPITAL, Texas, USA Volunteer, Dr Alexander Kalmanov (Clinical Activity) 05/2008 - 07/2008 SUNY UPSTATE MEDICAL UNIVERSITY, New York, USA Observer, Robert Lenox MD (Clinical Activity)

• Got oriented to the resident physician lifestyle during training at the University based medical residency program • Involved in history taking, physical examination, formulating diagnosis, management plans and case discussions during ward rounds and outpatient clinics 04/2008 - 05/2008 MEDICAL COLLEGE OF GEORGIA, Georgia, USA Visiting Scholar, David J. Terris MD (Clinical Activity)

• Worked as Visiting Scholar in busy tertiary-care referral hospital in otolaryngology-Head and Neck Surgery •Outpatient and inpatient, Operating room exposure • Learnt role of outpatient ultrasound neck in thyroid cases and Laryngeal nerve monitoring during thyroid surgery from Dr Terris • Worked with sub-specialists in Endocrine Surgery, Laryngology, Neurotology, Rhino logy, Head and Neck Oncologic Surgery • Participated in discussion on Tumor Board 10/2007 - 03/2008 INDRAPRASTH APOLLO HOSPITAL, India Resident Physician (Clinical Activity)

01/2006 - 09/2007 SHRI VYANIKATESH HOSPITAL AND RESEARCH CENTRE, India Junior Resident, Dr Raut (Clinical Activity)

Publications Research Publications

• Harris HW, Jaiswal P, Holmes V, Weisler RH, Patkar AP. Vitamin D deficiency and psychiatric illness - Supplementation might help patients with depression, seasonal mood disturbances.

• Vitamin D deficiency and psychiatric illness. 2013 Apr; Vol. 12(No. 04): 04. Status: Published.

• An interesting case of Recurrent multiple cranial nerve palsy- Dr N Surya, DrVisna, Dr Shah, Dr Pranay Jaiswal, Resident Award Papers, 12th Annual Conference of Bombay Neurologist Association, Bombay Hospital, April 20, 2014, Mumbai, Publication Status: Published. Poster Presentation

• Jaiswal P.. (2005, October). Primary Health Center (PHC) guidelines for Leptospirosis. Poster presented at: Dept. of Preventive and Social Medicine meeting; Nagpur, India. Oral Presentation

• Pranay Jaiswal (2014, March) - Recurrent Dysarthria in Young boy, An interesting case- in Bombay Neurologist Association Meeting at KEM Hospital Mumbai India

• Pranay Jaiswal (2013, December) - Transforming to Digital Healthcare - Top prize winning presentation at University of Aberdeen, Scotland UK

• Jaiswal, P.. (2010, March). Epigastric Abdominal Pain: Presentation and Differential, presented at: Master Educator Training Program (METP) Mini-Lecture series; Roseau, Dominica.

• Jaiswal, P.. (2010, January). Approach to a Patient with Dementia, presented at: METP Mini- Lecture series; Roseau, Dominica.

• Jaiswal, P.. (2009, September). Assessment of anxiety disorder. Oral Presentation presented at: Objective Structured Clinical Examination (OSCE) Psychiatry Interview, India.

• Jaiswal, P.. (2009, October). Assessment of suicidal risk presented at NIMHANS, India

• Jaiswal, P. (2005, October). Diarrhea Awareness and Prevention program, presented at: Dept. of Preventive and Social Medicine meeting with Villagers; Nagpur, India.

• Jaiswal, P. (2005, November). Leptospirosis outbreak and control, Guideline from WHO and CDC, at: Dept. of Preventive and Social Medicine meeting with Villagers; Nagpur, India. Hobbies & Interests

An Avid Traveler with interest in adventure trips as visiting national parks, hiking, trekking, trying out new cuisines and exploring nature documentaries. Apart from that, I also practiced Reiki-Chinese art of meditation and self healing.

Volunteer experience

• Veterans Affairs Medical Center New York -05/2008 - 07/2008 Pulmonary medicine

• Veterans Affairs Medical Center, Durham, North Carolina- 06/2010 - 12/2010 ER Room

• El Centro Hispano Summer Camp, Durham, North Carolina -06/2010 - 07/2010

• Epilepsy Foundation – 2014- 2016

Language Fluency

English, Hindi, Marathi, Punjabi, Gujarati, Kannada Other Awards/Accomplishments / Professional Development

Proficient in Excel and data analysis

Excellent verbal and written communication skills

Faculty Development Workshop "Using ACGME/SPRIT Competencies during the Basic Science Curriculum"

National Health Mission Epilepsy Foundation – Certificate of Appreciation, for excellent service rendered in free epilepsy detection and treatment camp

Light the Fire Guest Teacher Award, Ross University Preparatory School, Dominica

Medical Education Research Workshop Certification

Represented class for International Health in MBA

Continuing Medical Education CME and several workshops participant for Professional Development

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