Customer Service Medical

Nehal Mehta

** ******** *****, ********, *** *T*.

Cell phone: 647-***-****

E-mail: *********@*****.***

OBJECTIVE: To seek a challenging position where I can utilize my skills & enhance my career objectives.

EDUCATION

Insurance Institute of Canada -Toronto

CIP (Chartered Insurance Professional), completed 2 levels. in Toronto

Accounting and Commerce (B.COM)

Bachelor's Degree

Financial Management (DFM)

Diploma

Franchise Training Institute

Certified Franchise Expert (CFE)

Studied French at College Merici- Quebec

LANGUAGE SKILLS

English, French (Basic)

EMPLOYMENT HISTORY:

Franchise Boss Inc

Founder/ Franchise Business Expert - October 2018 till date

Help individuals achieve the independence and financial rewards associated with business ownership.

Work with each client to find the right franchise or business opportunity for them.

Offering expert advice and assist with Market Research and Due Diligence.

Offering a seamless customer service/experience

Aviva General insurance company of Canada

Accident Benefits specialist - June 2015 to September 2018

Investigate motor vehicle accident injury claims

Determine & interpret policy coverage, adjust financial reserves, and comply with the Ontario Statutory Accident Benefits Schedule (SABS).

Responsible for the investigation, negotiation and resolution of complex claims

Gather information at its earliest stage from the customers, health practitioners, employers, police, plaintiff lawyers, accountants, other insurers, witnesses, etc.

Make decisions by considering all information, consulting resources, and pulling on expertise when required

Prepare written correspondence to claimant regarding claim decision with specific reference to applicable legislation

Provide excellent customer service by focusing on customer demands, communicating in a manner that is simple and easy to understand, and actively handling the claim to closure

Effectively negotiate and settle claims to their conclusion either through settlement meetings, mediation or otherwise.

Actively participate in coaching and training sessions, and collaborate with team members

RBC Insurance Company of Canada

Senior Medical Case Manager/ Travel Claims – Jan 2012 till June 2015

Manage ambulatory care medical files: calling for medical reports, reviewing medical reports, authorizing appropriate investigations and determining next steps in order to complete the management of a file

In depth knowledge of all products under Travel claims including RBC VIC, RBC Visa Credit Cards, THP, Amex policies and credit cards, GWL, Manulife

Develop specific case management plans in accordance with appropriate insurance benefits for clients

Manage assigned claims, recognizing cases based on severity/complexity protocols and following the escalation process for high-risk cases.

Control risk and authorize claim payments within delegated authorities and ensure cost effective claims administration

Demonstrated commitment to taking ownership & accountability of client problems at first point of contact

Provide mentoring and coaching to less experienced claim professionals to increase their expertise and improve benchmark standards

Claims First Response Agent, - Feb 2011- Dec 2011

Opened post trip travel insurance claims such as baggage and flight delays, purchase security on visa credit cards and dental, medical claims upon arrival

Ensured accurate information, travel dates, loss dates and any other important details are obtained

Advised clients of insurance benefits, exclusions and conditions depending on their case

Generated claim forms and set requests for email or mail to clients

Achievements at RBC

RBC Performance Nominee – 4 occasions

Mentored and coached a new class/ ICU batch on the floor for 2 weeks alongside with QSS

Consistent Audit scores of 97 and above with excellent product knowledge

Consistent client compliment scores and very high likelihood to recommend

TECHNICAL SKILLS

Proficient in: Microsoft Word, Power point, Access and Excel, Travel AS400.

Working knowledge of Sage and ACCPAC accounting software, HCAI, Claims software

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