Shino Varughese
Dubai,UAE
Summary
Results-driven Management professional with eleven years of experience in EB medical operations, production management, organizational development and team building within diverse industries. Highly adept in planning, coordinating and executing successful production strategies. Track record of improving operational stability, efficiency and profitability. Strong collaborator with senior stakeholders, effectively prioritizing activities, translating business requirements into solutions and achieving defined objectives. Applies strong analytical and critical thinking skills to solve complex operational problems. Demonstrated history of meeting company goals and promoting best practices. Thrives under pressure and adapts to challenges with ingenuity and resilience.
Overview
14
14
years of professional experience
18
18
years of post-secondary education
1
1
Certification
Work history
General practitioner
Stephen's Hospital
New Delhi, India
2009.12 - 2011.01
- Date of appointment: 06th May 2011
- Departments worked in : Cardiology and Medical Insurance.
- Provided outstanding patient care through considered consultations, telephone triage, medication reviews and clinical administration.
- Consulted with patients about special needs, cares and concerns throughout treatments.
- Assisted patients with medication management, providing detailed information on contraindications to ensure patient health and safety.
- Maintained a patient-centred approach through continued compassionate care and adherence to best medical practices.
- Responded to patients' concerns by referring to their medical history and performing diagnoses, investigations, treatments and referrals as appropriate.
- Advised patients on post-treatment care options, at-home plans and effective rehabilitation.
- Collaborated with nurses to triage and prioritise patients in high-pressure situations, making rapid and effective decisions.
- Maintained confidentiality and impartiality in all patient interactions to maintain data protection.
Internship trainer
Rashid Hospital
Dubai, UAE
2011.04 - 2012.02
- Rashid hospital is one of the premier medical facilities for emergency, trauma, critical care and ambulatory care.
- It is a 500 bedded Multi-specialty Referral Hospital and is certified by the Joint Committee International (JCI)
- The Trauma Centre within the Rashid Hospital is a facility which is part of the Dubai Government Department of Health and Medical Services.
- It is one of the busiest emergency department in the region and ranks as one of the largest Trauma Centres worldwide.
- Departments worked in : Cardiology, Gastroenterology, Psychiatry, Primary Health Care, Paediatrics, Paediatric Surgery, General Surgery, Emergency Medicine, Obstetrics &Gynaecology.
Team leader- Medical department
Al Buhairah National Insurance Company
Dubai, UAE
2012.03 - 2015.03
- Professionally handled difficult customer complaints and objections to maintain first-class customer service standards.
- Led performance reviews and tailored employee feedback to facilitate professional development.
- Provided leadership and direction for employees, supervising activities to drive productivity and efficiency.
- Fostered positive employee relationships through communication, training and coaching.
- Drove team to consistently exceed critical Key Performance Indicator (KPI) targets by up to 90%.
- Progressed to Team Leader position within 12 months working at company.
- Streamlined processes to achieve efficiencies and cost savings.
- Supervised and mentored eight multidisciplinary team members.
- Analyzed Key Performance Indicator (KPI) data to identify trends and achieve team goals.
- Reached high-quality standards through audits and testing.
- Resolved employee relations issues and navigated disciplinary proceedings.
- Designed and implemented training to further develop staff based on business goals.
Senior team leader
AXA Global Healthcare
Dubai, UAE
2015.04 - 2018.09
- Developed strategies to promote team member adherence to company regulations and performance goals.
- Produced weekly, daily and monthly activity reports and forecasts.
- Set clear team goals and delegated tasks and set deadlines.
- Discovered training needs and provided coaching.
- Conducted team member meetings and updated members on best practices and continuing expectations.
- Professionally handled difficult customer complaints and objections to maintain first-class customer service standards.
- Recruited, trained and developed 11 team members.
- Demonstrated sales strategies and customer service best practices to enhance team performance.
Medical Board Manager
AXA Global Healthcare
Dubai, UAE
2018.10 - 2023.11
- Manage and lead the team by ensuring Service Level Agreements (SLA) of the Client is always met based on our contractual agreement.
- Claims management- Handling a team of eleven team members who are my direct reporters, it would become my sole responsibility to supervise their performance , make sure the claims are adjudicated accurately by providing the team with adequate training and coaching manuals, conduct monthly quality checks especially claims to identify common team processed errors and arrange meetings to provide necessary feedbacks to the relevant team members to ensure mistakes are never repeated and are kept to a minimum.
- Manages strong relationship with our TPAs by performing efficient claims handling and communication with our partners almost daily basis
- Monitors and ensures compliance with any regulatory changes and requirements.
- Based on medical claim reports of existing clients, I evaluate to understand the high value claims, claims which are subject to potential high risk of recurrence, identify trends in claim utilization by extracting and analyzing reports and predict the potential future claim costs related to the relevant medical conditions for the remaining period in the policy year
- Working closely with our AGH sales team in the Gulf to advise prognoses of medical conditions associated with high value claims identified by generating the claims report of existing clients
- In addition to the mentioned, I work with our sales team to calculate profit - loss ratio of Individual and several SME group schemes.
- Conducting Close File review (CFR) of the past year claims to identify potential claims leakage, identify provider trends, record the top diagnoses and audit claims which are of high value and show suspicious trends such containing most repeated investigations, tests which are not medically indicated as opposed to the mentioned diagnoses, etc.
- For the launch of our new system, I was working closely with our project team for the past 3 years in order to setup our Individual quotation module called QMS (Quotation Module System) and its entire framework as well as create an Underwriting process map for the team as well as our Gulf sales team.
- I would test the functionalities of the system keeping the requirement of being user friendly and efficient for our clients in mind, identify technical errors and defects, taking relevant notes and providing feedback to the business stakeholders.
- I would document work around for defects which could not be fixed, and which required major developments for our sales team to understand and be aligned with in order to make the work process smooth as possible.
- Monitor and mentor team performance in achievement of the Key Performance Indicators
- Manage complaint resolution process.
- Handle escalated calls from Executives and ensure a resolution is achieved.
- Hold weekly meetings to delegate team task as per process requirements.
- Plan and manage the monthly roster for the Medical Authorization Team, ensuring adequate staffing of all the Shifts are met, as per business requirements.
- Actively participate in the recruitment drive by assisting the manager in the interviews, reviews and retention of team members.
- Mentor new hires and ensure their training plan.
- Support the Case Managers.
- Work closely with the Supervisors to monitor agent productivity.
- Solving complicated In-patient and Out-patient claims and even Pharmacy approvals.
- Conducting monthly quizzes, monthly Quality checks for team members, conducting one to one meeting with individuals to understand training needs and arranging necessary coaching sessions for each one depending upon the field which requires improvement.
- Thorough evaluation of Individual and SME quotes, assessing whether the declared medical conditions require additional loadings to capture the risks or whether they are simple conditions which do not require any additional loadings.
- As for our International plans, we deal primarily with Inclusion underwriting, where our members choose to pay an extra premium in addition to the standard premium to have their declared preexisting medical conditions included as benefits in their plans.
- My primary role was to advise our commercial team located in the UK, regarding what conditions would pose a risk moving forward and advise specific benefit wordings relevant to the medical conditions (whether it is for renewal of an existing policy or whether it is related to new business).
- I coordinate with our commercial team in the UK regarding the applicable loadings and then relay to our AGH sales team in the Gulf who would then coordinate with the client accordingly.
- Answer all incoming calls related to medical authorization claims following the company guidelines and protocols as per the workload.
- Conducting higher authority validation for all high value medical Claims received.
- Thorough review of Claims and ensuring that there is no missing or incomplete information.
- Approval of cases if in compliance with the company's policy rules and regulations.
- Prepare correspondences for second opinion to doctors at Medical Centres and in hospitals, if in case of any doubts regarding the cases.
- Address difficult situations or customer complaints and come up with complete resolutions to the problem. The unresolved issues will be escalated and addressed together with the Senior Management.
- Maintaining meticulous records of Claims and follow up on lapsed cases.
AGH Operations Manager- AXA Global Healthcare
GIG Gulf Insurance (previously known as AXA)
Dubai, UAE
2023.12 - Current
- Monitored and reviewed operational performance, aiding improved business strategy to maximise productivity.
- Developed, recommended and implemented strategies to improve employee work quality and speed.
- Served as key corporate representative, liaising with various stakeholders in support of operational excellence.
- Maintained faultless quality control standards, resulting in reduced downtime and maximised revenue.
- Minimised discrepancies by effectively training employees on best practices, policies and procedures.
- Supported company growth by working constructively with sales team members, generating new business opportunities.
- Reduced operations costs and headcounts to significantly increase department profitability.
- Streamlined operational efficiencies by establishing and implementing effective programmes.
- Examined problem-solving strategies, highlighting development opportunities to improve organizational operations.
Education
Higher Secondary Education -
Sharjah Indian School
Sharjah 1990.05 - 2004.04
Bachelors of Medicine and Bachelors of Surgery (M.B.B.S) - Medicine
Vinayaka Missions University
Salem, India 2004.12 - 2009.03
P.G Diploma - Hospital Administration
Apollo Hospital Administration
New Delhi, IndiaAAPC CPT coding certified - undefined
Skills
- KEY TRAITS
- Core Competencies: Logical Reasoning ~ Analytical Skills ~ Training Skills ~ Strategy Execution ~Team Building ~ Oral & Written Communication skills
- Self-motivated, result oriented professional
- Work well in a high-pressure environment and has an eye for accuracy and detail
- Appreciations received from my ExComs on delivering exceptional outcome in terms of claims savings, complaints resolutions, system enhancements
- Display good leadership skills by building efficient teams, being proactive in nature and having the ability to work independently
- Creative in problem solving, quick learner, and able to develop new ideas
- Sound medical knowledge and vivid knowledge in the field of medical insurance
- Cost containment for the team while following accurate CPT coding guidelines
- Well versed with underwriting guidelines, claim processes as well as pre-authorization
- Team coaching and providing regular feedbacks to improve team performance and meet up with KPIs
Accomplishments
- Accustomed to adapting to a fast paced and ever-changing insurance market.
- Extensive experience implementing and managing operational plans with the ability to identify address performance-related issues always exceeding client's expectation.
Languages
English
Fluent
Hindi
Fluent
Arabic
Beginner
Malayalam
Fluent
French
Beginner
Certification
AAPC- Certification in medical coding/DRG/HCPCS/CPT/ICD expertise.
AAPC certification in medical coding/ DRG/ HCPCS/ ICD/CPT
Certified medical coder- Expert in analysis of topics related to medical coding, determining the relevant DRG codes to be calculated basis the provided primary and secondary diagnoses thus determining the severity grade of the DRG.
Timeline
AGH Operations Manager- AXA Global Healthcare
GIG Gulf Insurance (previously known as AXA)
2023.12 - Current
Medical Board Manager
AXA Global Healthcare
2018.10 - 2023.11
Senior team leader
AXA Global Healthcare
2015.04 - 2018.09
Team leader- Medical department
Al Buhairah National Insurance Company
2012.03 - 2015.03
Internship trainer
Rashid Hospital
2011.04 - 2012.02
General practitioner
Stephen's Hospital
2009.12 - 2011.01
Bachelors of Medicine and Bachelors of Surgery (M.B.B.S) - Medicine
Vinayaka Missions University
2004.12 - 2009.03
Higher Secondary Education -
Sharjah Indian School
1990.05 - 2004.04
P.G Diploma - Hospital Administration
Apollo Hospital Administration