mohd kader

*  Complete Supervision of the entire branch including the medical Claims the Branch *  Networking Policy Maintenance ,Provider relations and International Claims management *  Overall Supervision of the Approval desk &Customer care . *  Organization, implementation of the Anti-fraud team and monitoring its activities. *  Organizing and crafting the AXA PPP [Reinsurer] reports effectively. *  Commercial settlement of high value ,disputed claims . *  Conducting the CME at various levels to update the academic and to implement the same. *  Conducting the interviews for the candidates for various posts *  Provider and client awareness meetings on anti-fraud activities *  Training the subordinates on updated tools and implements. *  Client meetings on projects /productivity / marketing strategies

* Senior Medical Consultant: * Able to make appropriate decisions on each claim, maintain high professional profile, able to apply medical knowledge and technical knowledge while dealing with medical claims. * Excellent academic profile and outstanding communication skill * Review employee records to monitor quality of care administered and to determine legitimacy of admission, treatment, level of care and length of stay in a health care facility, to comply with government and insurance company reimbursement policies Claims coordinator * Hospital Relation executive – scheduled hospital visits, follow up and case discussion. * Communicate with hospitals, provider and non-provider doctors to ensure that appropriate care is being given to patients and to clarify questionable modes of treatment and claims

Reporting to the Head of TPA, Leading a team of 04 experienced medical auditors . Scrutinizing the high value claims . Attending the reconciliation meeting . Advising the approval department. Sketch out the schedule on weekly basis , make reports also.Set the terms and strategies for the auditing provider vise. Advising a group of 24 claim processors.