PRANAV PRATIK
Senior Finance Executive
Patna
Summary
- A highly motivated and experienced Health Insurance-TPA department with an in-depth knowledge of the insurance industry. Possessing excellent customer service, communication, and problem-solving skills, as well as the ability to work collaboratively and independently. Process insurance claims and review for accuracy. Ensure compliance with applicable laws and regulations. Establish and maintain relationships with insurance providers. Prepare and submit reports to management. Negotiate with insurance providers to secure the best coverage and rates. Monitor claims processing and payment. Analyze data to identify trends and opportunities for improvement .
Overview
6
6
years of professional experience
4037
4037
years of post-secondary education
4
4
Languages
Work History
Senior Finance Executive
JAY PRABHA MEDANTA SUPER SPECIALITY HOSPITAL
01.2024 - Current
- Follow-up of Payment Recovery from TPA/PSU/CORPORATE/ECHS within Stipulated time
- Monitor Dockets needs to be send to TPA/Corporates for with in TAT
- Handled Query of all credit bills
- Visit to all corporate, TPA & major insurance associations to get business
- Prepare Mou document for approval and submission of time
- Timely renewal of agreements/Mou
- Regular follow up of outstanding & assurance of timely realization of Payment
- Timely submission of outstanding bills to respective companies in co-ordination with billing Manager
- Timely recovery of outstanding bills
- Oversee and streamline billing and collections processes
- Work on Deduction analysis to control deductions on credit bills
- Managing Billing/TPA/Corporate Dept.(Client/Payments/Settlements)
- Handling debtor management of TPA/PSU/Corporates
- Monthly wise preparation of debtor agencies report
- Create daily business report
- Prepare daily/Weekly reports as per their standard formats
- Developing Training module and training of staff
- To manage training sessions for all (like Hospital information system, TPA Processing, Brand service standards, NABH etc)
- TPA/Corporate/PSU Bills dispatch and follow up for payments
- Handling patient refund process
- Handling Discharge Process
- Arranging team activities for motivation
- Quality analysis (Time taken for discharge, gap between estimates given and actual bill, billing error)
- Handling of patient queries related to billing
- Online Bills submission of IPD & OPD on ECHS & other portals (like NTPC and CGHS)
- Follow up of credit bills corporate patient and recover the bill for hospital
TPA CUM PR & CSR
KURJI HOLY FAMILY HOSPITAL (KHFH)
07.2022 - 12.2023
- Third Party Administrator/Assessor
- To function as intermediary between the insurance providers & the policy holders for prompt negotiation
- To execute all the paper work for the policy holders required for availing any cashless hospitalization services
- To do the process of claims & settlement on priority basis
- Do follow up of unsettled cases
- Prepare & record all the documents pertaining to claims, grievances, follow-ups etc
- Coordinate with all the departments for claim processing
- Responsible for maintaining peaceful and healthy relationship between hospital and all the stakeholders
- Deal with patient's/attendant's /general public grievances and resolve them amicably on priority basis by coordinating with the concerned department
- To build and develop strong rapport with all the stake holders
- To act as the coordinator for the hospital's initiatives and building relationships with community partners and key stakeholders
- Develop and execute CSR programs as well as conducting periodic program reviews to assess outcomes & effectiveness
- Responsible to widen the reach of hospital to materialize more inflow of patients
- Look for new potential donors and do regular follow up
- To carry out other tasks as and when required in the department or asked by the administrator
Customer Success Manager
Defmacro Software Private Limited (Cleartax)
11.2020 - 06.2022
- Having 1.5ear of experience in Taxation as GST expert and Business management at Cleartax (Defmacro Software Pvt
- Ltd.)
- Handling escalation calls and resolve their issues asap
- Working various responsibilities In the Organization as a Key Account Manager (CA GST Filing)
- Reactivation Executive, Success advisor, senior support & success Manager
- Analyzes the goals of the customer and their own company, maps out the steps to achieve these goals, and then takes action to ensure they are met
Showroom Manager
Classic Floorings & Interiors Private Limited (Square Foot)
12.2019 - 07.2020
- Managers work in retail stores selling expensive items like appliances and furniture
- Role is making sure the showroom attracts clients and encourages them to buy
- Common work activities include coordinating staff, maintaining cleanliness, budgeting, and arranging merchandise
Showroom Supervisor
Goldmedal Electricals Private Limited ( G E P L )
08.2018 - 11.2019
- Retail store managers, store supervisors are responsible for overseeing the daily operations of a retail store, including product availability and pricing
- Other duties entail managing the staff and customer services, and controlling finances
- Train new employees and schedule shifts
Education
B.A -
LMNU
12th - undefined
Bihar Secondary Examination Board
10th - undefined
CBSE
Master of Hospital Administration -
DY PATIL VIDYAPEETH
PUNE01-2024
Skills
- Claims Management
- Risk Assessment
- Policy Analysis
- Stakeholders communication
- Fraud Detection
- Strategic Planning
- Conflict resolution skills
- Advanced Data Analytics for Insurance
- Team oriented
- Confident communicator
- Good leadership skills
Computerawareness
- MS Excel
- MS Office
- Pivot
- Internet
Personal Information
- Total Experience: 6+ Years
- Notice Period: 60 Days
- Date of Birth: 12/01/95
- Marital Status: Married
Timeline
Senior Finance Executive
JAY PRABHA MEDANTA SUPER SPECIALITY HOSPITAL
01.2024 - Current
TPA CUM PR & CSR
KURJI HOLY FAMILY HOSPITAL (KHFH)
07.2022 - 12.2023
Customer Success Manager
Defmacro Software Private Limited (Cleartax)
11.2020 - 06.2022
Showroom Manager
Classic Floorings & Interiors Private Limited (Square Foot)
12.2019 - 07.2020
Showroom Supervisor
Goldmedal Electricals Private Limited ( G E P L )
08.2018 - 11.2019
12th - undefined
Bihar Secondary Examination Board
10th - undefined
CBSE
B.A -
LMNU
Master of Hospital Administration -
DY PATIL VIDYAPEETH
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