- New Delhi, IN
- £12 /hr
- Available now
I am a doctor with more than 7 years of experience in health insurance. I have worked as a medical underwriter, medical summarizer, utilization review report writer.
Area Covered:more...I am a doctor with more than 7 years of experience in health insurance. I have worked as a medical underwriter, medical summarizer, utilization review report writer.
Area Covered: Medical Underwriting, medical utilization review report writing, medical summarization
Job Title: Medical utilization review writer
Company: U.S. client
Description: • Assessment of the medical necessity and appropriateness of medical treatment or services, for determining the availability of payment for those treatments or services. Dealing with workers compensation cases.
• Gathering clinical information and applying the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Utilizing clinical experience and skills in collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Job Title: Medical summarizer
Company: Travelers client ( EXL noida)
Description: • Working for St. Paul Travelers, US. Doing medical summarization of claim records. Summarizing records of hospital stay and of subsequent treating physicians, along with the results of diagnostic testing. Including the treating physicians' comments regarding causation of injuries, prognosis and permanency with listed medical expense. Adding separate note to the attorney pointing out the missing records, red flags, and problematic medical issues.
• Have worked on all type of records example orthopedic, chiropractic, cardiology, neurology, orthopedic, PT, OT, speech therapy, rehabilitation, hospital stay etc.
Job Title: Medical underwriting
Company: Lloyds TSB client (Steria, Noida)
Description: • Was doing medical underwriting and risk analysis for Scottish Widows Insurance, UK (An acquisition of Lloyds TSB Group, UK)
• Would decide the premiums, or decline the policy on the basis of applicant"s medical problems, medications and any previous claim taken.
• On behalf of the team interacted with client for solving complex underwriting issues.
• Preparing daily MIS reports, attrition report, absence management report, quality analysis reports, billable utilization reports and sending them to higher management.
• Went to Edinburgh, UK at client site for 3.5 months for training of medical underwriting. Went again for a period of 1 month for learning new application in use.
• Good domain knowledge of underwriting- both medical and financial underwriting. Ability to judge various medical and financial documents and arrive at proper risk evaluations.
• Met and exceeded process deliverables as per customer
• Excellent knowledge of tools like Minitab, MS Excel, MIS, Word and Power Point.
Underwrite Policies up to £250k.
Decision limits for life rating of +150%,critical illness+100%and waiver of premium +100% as per Swiss Re guidelines.
Trained in both network and direct sales force policies.
Job Title: Underwriting support
Company: GE Capital
Description: • Digitized the insurance application form
• Ensured the routing of the insurance application to the correct queue-the rated queue i.e. some rating would be applied on the policy, the accepted queue i.e. accepting the policy without any rating, the declined queue i.e. declining the policy or the medical queue i.e. if we need further information.
• Handled queries of the FTE"s on shop floor.
• Discussed perception cases with the client.
Education Summary: I have done B.A.M.S.(Bachelor of Ayurvedic Medicine and Surgery). This is a 5.5 years course and the course comprises of all the subjects of modern medicine as well as indian medicine.
I have done certification in medical transcription. I am six sigma green belt certified.
I have completed licentiateship in insurance from Insurance Institute of India.
I am pursuing Post graduate diploma in project management for ICFAI.
Dr. Bhavna V.