Anjum Elachola
Summary
Armed with a rich tapestry of experience and expertise in Health Insurance Operations and Claims, meticulously refined over years of navigating the nuanced local market dynamics. I am on the lookout for a transformative career opportunity that allows me to leverage my profound knowledge, razor-sharp skills, and steadfast commitment to deliver concrete outcomes, thereby making a substantial impact on the company's journey of growth and success.
Overview
14
14
years of professional experience
Work history
Senior Medical Claims Manager
RAK Insurance
United Arab Emirates
05.2021 - Current
Medical Claims Manager
RAK Insurance
United Arab Emirates
01.2019 - 04.2021
Senior Medical Claims and Audit Officer
RAK Insurance
United Arab Emirates
10.2017 - 12.2018
Senior Claims Officer
RAK Insurance
United Arab Emirates
04.2015 - 09.2017
Medical Claims Coordinator
National Life & General Insurance
United Arab Emirates
11.2013 - 04.2015
Trainee Clinical Research Coordinator
Iqraa International Hospital / ICRM, India
India
06.2010 - 12.2010
Medical Officer
Shri Sivaa Hospital, India
India
05.2010 - 05.2012
Education
Certified Professional Compliance Officer (CPCO) - undefined
American Academy for Professional Coders USA
Managed Healthcare Professional (MHP) 2021 - undefined
Health Insurance Plans (AHIP) - USA
Professional, Academy for Healthcare Management (PAHM) 2021 - undefined
Health Insurance Plans (AHIP) - USA
Lean Six Sigma Black Belt in Healthcare-2020 - undefined
Aveta Business School
Health Care Anti-Fraud Associate (HCAFA) 2019 - undefined
Health Insurance Plans (AHIP) - USA
Certified Risk Adjustment Coder (CRC) 2018 - undefined
American Academy for Professional Coders USA
Cert CII - 2017 - undefined
Charted Insurance Institute UK
Certified Professional Medical Auditor (CPMA) -2016 - undefined
American Academy for Professional Coders - USA
Certified Professional Medical Coder (CPC) -2016 - undefined
American Academy for Professional Coders - USA
Certification in Clinical Research - 2010 - undefined
IFCA India
Bachelor of Alternative Medicine & Surgery (BHMS) 2004-2009 - undefined
Dr. MGR Medical University, India
Skills
- Comprehensive understanding of various aspects of health Insurance administration and management and specifically belongs to areas as below I also have work expertise and demonstrate same across my current engagement, and I strongly believe that these are essential for ensuring quality patient care while managing costs effectively
- Health Claim Lifecycle Management: Spearheading the end-to-end process of managing health insurance claims, from initial submission to final reimbursement This encompasses meticulously verifying eligibility, processing claims with precision, and adeptly resolving any arising concerns
- Case Management: Orchestrating comprehensive care plans for patients, with a focus on those facing intricate medical challenges or chronic ailments Demonstrated expertise in optimizing patient care, resource allocation, and streamlining healthcare system navigation, all while maintaining a cost-efficient approach
- Health Claim Process and Compliance Audit: Conducting audits to assess the accuracy, efficiency, and compliance of health claim processes within the regulations and industry standards This helps identify areas for improvement and ensure adherence to regulatory requirements
- Health Declaration and Customer Onboarding Process Audit: Evaluating the procedures for collecting health declarations and onboarding new customers in the healthcare system This ensures that accurate information is obtained from customers and that the onboarding process is smooth and efficient
- Business Process Improvement: Analyzing and optimizing various business processes within the healthcare organization to enhance efficiency, reduce costs, and improve overall performance This may involve streamlining workflows, implementing new technologies, or redesigning procedures
- Claim Cost Containment Measure Assessment and Implementation: Assessing strategies to control healthcare costs associated with insurance claims, such as negotiating lower rates with providers, implementing utilization management programs, or promoting preventive care initiatives
- Provider Audits and Reconciliation: Auditing healthcare providers' billing practices and financial records to ensure accuracy and compliance with contractual agreements and regulatory requirements Reconciliation involves resolving discrepancies and ensuring that payments are made correctly
Additional Information
References and other additional details are available upon request. Please feel free to customize this CV further according to your preferences or any additional information you'd like to include.
Custom
A unique blend of strategic thinking, analytical prowess, and hands-on experience in Health Insurance Operations and Claims. My ability to navigate complex challenges, coupled with a strong focus on efficiency and accuracy, enables me to drive operational excellence and deliver measurable results. I am dedicated to fostering collaborative relationships, identifying opportunities for improvement, cost containment, and implementing innovative solutions that align with the company's goals and contribute to its long-term success.
Personal Information
- Title: CPC, CPMA, CRC
- Date of birth: 10/11/86
- Gender: Female
- Nationality: Indian
- Visa status: Employment visa
Timeline
Senior Medical Claims Manager
RAK Insurance
05.2021 - Current
Medical Claims Manager
RAK Insurance
01.2019 - 04.2021
Senior Medical Claims and Audit Officer
RAK Insurance
10.2017 - 12.2018
Senior Claims Officer
RAK Insurance
04.2015 - 09.2017
Medical Claims Coordinator
National Life & General Insurance
11.2013 - 04.2015
Trainee Clinical Research Coordinator
Iqraa International Hospital / ICRM, India
06.2010 - 12.2010
Medical Officer
Shri Sivaa Hospital, India
05.2010 - 05.2012
Certified Professional Compliance Officer (CPCO) - undefined
American Academy for Professional Coders USA
Managed Healthcare Professional (MHP) 2021 - undefined
Health Insurance Plans (AHIP) - USA
Professional, Academy for Healthcare Management (PAHM) 2021 - undefined
Health Insurance Plans (AHIP) - USA
Lean Six Sigma Black Belt in Healthcare-2020 - undefined
Aveta Business School
Health Care Anti-Fraud Associate (HCAFA) 2019 - undefined
Health Insurance Plans (AHIP) - USA
Certified Risk Adjustment Coder (CRC) 2018 - undefined
American Academy for Professional Coders USA
Cert CII - 2017 - undefined
Charted Insurance Institute UK
Certified Professional Medical Auditor (CPMA) -2016 - undefined
American Academy for Professional Coders - USA
Certified Professional Medical Coder (CPC) -2016 - undefined
American Academy for Professional Coders - USA
Certification in Clinical Research - 2010 - undefined
IFCA India
Bachelor of Alternative Medicine & Surgery (BHMS) 2004-2009 - undefined
Dr. MGR Medical University, India
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