22 yrs exp, in tpa cell

MY INTRODUCTION

DR. PAWAN SHARMA

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

Phone : 981*******

PROFILE :

A mature person able to keep organizational benefits on priority with ethical work standards & strong team leader & motivator that works with great zeal

& enthusiasm.

WORK EXPERIENCE :

23+ YEARS WITH TPA & INSURANCE:

1. Worked as a Sr. Physiotherapist in INDRAPRASTHA APOLLO HOSPITAL, New Delhi – 110044.

2. Worked as a Sr. Physiotherapist (HOD) IN NIMT HOSPITAL & DENTAL COLLEGE and GROUP OF NIMT HOSPITAL 100 bedded multi-super speciality hospital plot no – 41, Knowledge Park-I, Kasna road, Greater Noida

(U.P.).

3. Worked as Senior manager-claims department in STAR HEALTH & ALLIED INSURANCE CO. LTD.

4. Worked in KAILASH HOSPITAL, LTD, Greater Noida as a (HOD) in TPA cell

(TPA, ECHS, GGHS) panels.

5. Presently working in TPA DEPARTMENT & INSURANCE AS (HOD) YATHARTH MULTI-SUPER SPECIALITY HOSPITAL, 400 BEDDED Greater Noida till date.

EDUCATIONAL QUALIFICATION :

M.B.A (HOSPITAL ADMINISTRATION) from GEETANJALI UNIVERSITY, UDAIPUR RAJASTHAN (India).

A.I.S.S.E. from NALWA LOVELY PUBLIC SCHOOL UJAHAPANIPAT, Haryana, 1993 1ST division.

A.I.S.S.E. from KENDRIYAVIDYALAYA AIR FORCE STATION (AFS), Gurugram March 1990 1ST division.

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PROFESSIONAL QUALIFICATION :

(BACHELOR OF PHYSIOTHERAPY) from KASTURBA MEDICAL COLLEGE, Manipal (1999) with 1ST division.

IT SKILLS: Basic fundamentals (MS office and PPT). CERTIFICATION AND HONORS:

Appreciation certificate during covid protocol session. SKILLS & JOB DESCRIPTION :

Provide medical opinion for Health insurance claims.

Processing of cashless requests & health insurance claim documents.

Investigator meeting & handling in various TPA insurance company.

To ensure protocol compliance for all the events and the procedure.

To identify potential eligible patients.

Evaluating patient status for safety and assure optimum health care.

TPA files follow-up and closure.

Processing error to be maintained < 0.25%.

TPA in hospital management.

Claim / Cost management in TPA’S.

Maintain time management and interpersonal skills/Audit Fication of medical claims and settled the queries.

Emphasis on quality of content, attention to details.

Emergency claims processing and TAT maintenance.

Handling of Pre authorization request form approval in various insurance company.

Solving query reply in TPA and in various insurance companies.

Coordination with the senior consultant doctors with timeline-period.

Medical scrutiny in all TPA cases.

Proficient medical terms & system.

Ailment wise ICD & ensuring coding.

Manage volumes effectively & efficiently to maintain turnaround time of processing cases.

Team management and development.

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EXTRA CURRICULAR ACTIVITIES:

Participated in various sports and cultural events of school and college.

Organized various events at college level including fresher’s eve and active member of various clubs and institutions.

STRENGTHS:

Confident, decision-making, consistency in relationships, hardworking, meeting deadlines effectively.

WEAKNESS: Shyness, impatience with bureaucracies & inexperience with specific software or a non essential skills.

HOBBIES : Travelling exotic places.

PERSONAL DETAILS :

Date of birth : 29, January 1982

Marital status : Married

Spouse Name : Mrs. Santosh Sharma

Kids : 2 KIDS (Shaurya & Annanya)

Nationality : Indian

CORRESPONDENCE ADDRESS: House No. D-121, Sector P-3, Greater Noida, U.P. 201308. DECLARATION

I, hereby declare that all the above information details are true to the best of my knowledge.

Date:

Place:

(Dr. Pawan Sharma)

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