Medical Insurance

Curriculum Vitae - Dr Kshema Renju.

*.*+yr experience in UAE Medical/Healthcare

Insurance Industry.

Objective :

Be a dedicated and enthusiastic person with a diverse range of academic

experience. Eager to find a position offering long-term potential with a

structured, defined career progression in field of

Medical Insurance.

Experienced MBBS doctor with strong

knowledge in medical insurance related

activities .

Excellent network among Insurance companies,

TPAs and hospitals in the region.

Fluent in English, Hindi & Malayalam. Able

to read & write French & Arabic.

Solid & in-depth understanding of the

medical insurance terminologies, policies

and insurance practices.

Multitasked with high degree of motivation

and self-discipline.

Well versed with ICD/CPT/HCPCS codes.

Accomplished negotiator and facilitator.

Strong background working with and/or

liaising with international & local

insurance companies / TPA's.

Ability to build networks and relationships

with key stakeholders.

Experienced in working with TPA and hospital

environments.

Worked as a member of Quality Management

team to ensure implementation JCIA, DHA

procedures.

Strengths and Skills:

Education:

1. M.B.B.S: Bachelor of Medicine and Bachelor of Surgery from Dr. SMCSI

Medical College, Trivandrum, Kerala, India (2003 - 2009).

2. Licentiate Degree holder from Insurance Institute of India.

3. Associateship from Insurance Institute of India (Ongoing).

Work Experience :

Well Experienced and qualified professional with diverse range of

experience in the field of medical insurance industry in UAE.

Internship: Jan 2009 - Jan 2010

o Dr. SMCSI Medical College, Karakonam, Trivandrum, Kerala. (9

months.)

o Rural health training centre, Kazhakkuttam, Trivandrum,Kerala (

3 months).

Internship

1. At Dr. S M C S I Medical College :

Responsibilities

. Handling OPD, examining patients.

. Recording in - patient admissions.

. Taking ward rounds, checking in-patients, doing routine check up.

. Checking if patient case sheets are maintained properly

and updated.

. Supervising the therapy process being given to the patient

ensuring patient comfort and proper administration of therapy.

. Maintaining daily records of post operative patients, and

assisting in their postoperative recovery.

. Doctor on duty for camps - general surgery, ENT, community

medicine, ophthalmology.

Professional Experience :

1) Medical Officer in Medical Reimbursement Dept at

NAS Administration Services, Abu Dhabi, U.A.E.(June 2010 -

Aug 2010)

Responsibilities:

. Medical claims processing - inpatient and outpatient claims.

. Receiving physical copies / scanned copies of medical claims

from providers /members.

. Comprehensive and systematic claims processing with the claim

turnaround time kept to a minimum.

. Determining member's eligibility in accordance with terms and

conditions of applicable coverage as said by insurers/self

informed groups.

. Health care benefits management and adjustments relating to the

coverage conditions of each member.

. Financial services like remitting payment from the concerned

claimants, affecting payments to the providers/ members in

various currencies for/and on behalf of the respective payers.

. Issuance of payment bordereaux .

. Dealing with a vast reportoire of international clients and

their queries.

. Providing members guidance and assistance by answering queries

concerning the applicable coverage.

. Providing information about network providers - their location

and specialities.

. Explanation of benefits and providing reconciliation with the

various providers.

. Proposing VIP service to members identified as such by

insurers/self informed groups.

2) Medical Consultant in Pre- Authorization Dept at

NEURON LLC, Dubai.(22 Nov 2010-Oct 2012)

Responsibilities

. Medical management, including pre-authorization, case management

and utilization review.

. Determining members' eligibility and prompt issuance of

treatment authorizations to providers in accordance with the

terms and conditions of the applicable coverage as set by the

insurers or self insured groups.

. Issuing denials for those requests deemed either medically not

justifiable or not adhering to the policy terms and conditions.

. Giving verbal approvals for admissions, discharge and extensions

of stay for all IP admissions.

. Arranging second opinion with reputed specialists in their

concerned field where an expert opinion is beneficial.

. Emails to clients which includes both self insured groups and

insurance companies.

. Issuance of written approvals for pharmacy and out-patient

requests above a set monetary limit.

. Answering queries from the members regarding coverage, terms and

conditions of their policy etc.

. Attending calls from various hospitals/clinics for follow ups

and the like.

3.Insurance Coordinator in Medical Insurance Dept at

Belhoul European Hospital, Jumeriah, Dubai, UAE (March 2013 - Present)

Responsibilities

Insurance Management:

Responsible for Planning and organizing activities of the Insurance Department to

ensure the seamless insurance coverage of clinical services .

To train and educate, advice the management & staff on insurance matters.

Negotiation & enlisting of new / unlisted services to tariff at competitive rates.

Assists and reviews claims pre and post submission to determine completeness, accuracy

and collection of unpaid and denied claims

Prepare data analysis reports related to particular department or insurance companies.

Reflects organization mission, vision and values in management behavior

Provides performance reviews and takes corrective action

. Implements a system of regular competency assessment

Ensures that goals together with performance standards are aligned

with corporate

strategy and managed accordingly

Declaration

I hereby declare that the information provided above is true to

the best of my knowledge and belief.

Dr. KSHEMA RENJU

Email: ***********@*****.***

Address

Discovery Gardens

Dubai,

UAE.

Mobile -- 050 - 3578867

Date of Birth - 18.12.1985

Visa status - residence visa

Exp : 4.5yr+

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