Business Assistant Health Insurance
Resume:
CURRICULUM VITAE
Vinod Kumar Mukhiya
H.No- F – *25, C/O Ratanjit Singh
Lado Sarai, Mehrauli
New Delhi – 110030
Mobile No: 783-***-****
Email- ad5wsf@r.postjobfree.com
CARRIER OBJECTIVE
Seeking a challenging position, to utilize my knowledge and training with an organization that has the potential for growth and expansion and has high standard of performance.
To work for an organization that utilizes my skills and provides me with opportunities and upgrades my knowledge and skills.
PROFESSIONAL EFFICIENCIES:
Soft spoken, carefree, light-hearted and disciplined.
Pleasing personality.
In-depth knowledge of making Invoices and Packing lists.
Adapting expertise with the changing environment ACADEMIC QUALIFICATION
S.NO. DEGREE INSTITUTE YEAR OF PASSING
1. M.COM in Financial Management
Swami Vivekanand
University UP
2021-2023
2.
Bachelor of commerce (Accounts
Hones.)
Mithila University,
Bihar
2008-2011
3.
Senior Secondary Examination of
XIIth Class
C.M.Collage, Bihar
2007-2008
4.
Higher Secondary Examination of
XthClass
C.M.Collage, Bihar 2006-2007
ACHIEVEMENTS
Awarded Certificate of Appreciation for excellent work performance in Health Insurance TPA of India Ltd.
PROFESSIONAL HISTORY/EXPERIENCE
Health Insurance TPA Of India Ltd.:(November 2016 to Present) KEY RESPONSIBILITY AREAS
Initiating investigations based on request received from claims department & from claims Dump.
To establish cases of fraud and abuse based on claims dump and triggers provided by Claims Team from 21/11/2016 to till date.
Day to day management of cashless and reimbursement claims investigations.
Field verification as & when needed. Liaisoning with Investigation agencies and allocation of claims for investigation .
Follow-up with internal as well as with external investigators to ensure that Investigation reports are submitted to claims team within TAT.
Data maintained for claims assigned for verification & discrepancy detected. Maintain/Prepare/provide vast record without any difficulties and corrections. Coordination with investigators, claims, IT & Other teams to aide smooth functioning of the claim management and also to resolve their issues and doubts with in minimum time period.
According to triggers telephonic verification are being done both part hospital as well as Insured on daily basis.
Ensured quality of investigation and reporting is maintained for the cases investigated by in- house or external agency.
Coordination for scanning and tagging of investigation reports. Updating investigation data and report in to the system.
Keeping track of claims investigated by External agencies and preparing notes for payment.
Investigation Data sharing the MIS Team & RM Team as well as Insurance Company.
Based on the triggers, telephonic verification are being done. Field investigation carried out as and when claims assigned .
Claims assigning to External agencies and Internal team for investigation of claims and data maintained for claims assigned for verification & discrepancy detected.
Coordination with investigators, claims, IT & Other teams to aide smooth functioning of the claim management and also to resolve their issues and doubts with in minimum time period.
Keeping track of claims investigated by External agencies and in-house team. After receipt of investigation reports from External agencies and Internal team same are being updated in MIS and closed in system accordingly.
Investigation Data sharing the MIS Team & RM Team as well as Insurance Company.
Investigation Data sharing the MIS Team & RM Team as well as Insurance Company. Based on the triggers, telephonic verification are being done. Field investigation carried out as and when claims assigned . Claims assigning to External agencies and Internal team for investigation of claims and data maintained for claims assigned for verification & discrepancy detected. Coordination with investigators, claims, IT & Other teams to aide smooth functioning of the claim management and also to resolve their issues and doubts with in minimum time period.Keeping track of claims investigated by External agencies and in-house team. After receipt of investigation reports from External agencies and Internal team same are being updated in MIS and closed in system accordingly.
Raksha TPA Pvt. Ltd.-(November 2015 to 2016)
Role: Executive Claim Auditor
KEY RESPONSIBILITY AREAS
Entering the claims data into system.
Performed audit of the claims to ensure quality processing.
Performing audits on billing, medical coding, and patient care system.
Finding and reporting under-billing and over-billing to the billing department.
Identifying and enhancing strengths and weakness of the billing department.
Uncovering and resolving any issues related to incorrect billing codes or fraud in billing.
Investigated and protected the facility against fraud claims.
Modified the reimbursement process for cash paid in advanced.
Reviewed pre and post-payment audit reports and claim-transaction audit reports.
Resolved problems resulting from claim settlement.
Evaluate medical records for in accurate or missing documentation.
Verified that inventory and maintenance costs reported by various medical facilities within the health group were accurate.
G.D.Mangalam Exim Pvt. Ltd.-(May 2011 to November 2015) Role: Export Documentation Executive
KEY RESPONSIBILITY AREAS
Preparing Entire Export Documentation (Pre & Post Documents), Preparing Commercial Invoices & Packing List, Certificate of Origin, LC Documents, Preparing & Submitting BRC’s, Etc.
Direct Communication with overseas buyers through calls and emails.
Receiving Export Orders through E-mail and analyzes them to complete the shipping on time.
Direct communicate with international suppliers, service providers, logistic companies etc.
Knowledge of Exim policy, Custom Clearance process.
Filing Shipping bill (Complete knowledge of filing documents through ICEGATE )
Monitoring of ship’s ETA that we need to coordinate with Customers for obtaining Shipping Instructions.
Preparation of Bill Of Lading based on the final load list.
Checking of checklist, Documentation of all custom related documents
Keep track of invoices and prepare reports to expedite the billing process.
To ensure that shipments are in compliance with the laws and regulations governing the export industry.
Maintain records of payments
May act as a lead worker to other staff in the department. Clips Office Solution Pvt.Ltd.- (March 2010 to January 2011) Role: Export Documentation Executive
KEY RESPONSIBILITY AREAS
Knowledge & Handling of post shipment document which include commercial invoices, packing list, L/C documents, Exporting country certification, Customs/ Insurance declaration Certificate of Origin & many more document prepared as per customer requirement. SKILLS AND STRENGTHS
Good qualitative aptitude along with excellent grasping power and eagerness to learn.
Punctual, dedicated and consistent towards my work.
Like to interact with People to know them, understand and help them to solve their problems.
Always willing to learn new things with curiosity.
Hard working and dedicated to my work.
Ability to establish team work.
PERSONAL PROFILE
FATHER’S NAME Shri Avadh Mukhiya
GENDER Male
DATE OF BIRTH 14th May 1990
NATIONALITY Indian
MARITAL STATUS Unmarried
LANGUAGE KNOWN Hindi, English and Maithili
INTEREST AND HOBBIES
Reading News Papers, Magazines
Listening Music
Playing & Watching Cricket
Doing something new, creative and different
COMPUTER PROFICIENCY
Worked on Operating system: Windows XP/ Windows 7.
Well versed with MS Office tools, mainly consisting of MS Word, Excel, and PowerPoint.
Well proficient with Internet and e-mail.
DECLARATION
I solemnly affirm that the information given above is true to the best of my knowledge and belief. Date-
Place- New Delhi (Vinod Kumar Mukhiya)
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