Sangeetha Ragaseagran
Senior Executive- Claims Operation
Seremban
Summary
Highly motivated and ability to work in a team-oriented environment. Excellent in communication and interpersonal skills. Result oriented and has a desire to work in a performance-driven environment. Willingness to learn, open-minded and accept responsibilities. Self-confidence and able to work with minimum supervision. Enthusiastic and good adaptability to various situations. Emphasize quality and productive work.
Overview
16
16
years of professional experience
Work History
Senior Executive- Claims Operation
MCIS Life HQ
12.2021 - Current
- Handle medical claims and approval from TPA and reimbursement claims
- Liaise with clients and brokers through emails on SOB and company benefits
- Handle email enquiries from TPA, client and brokers
- Payment approval for claims from TPA and reimbursement
- Liaise with company employee benefit department for group policies enquiries
- Claim settlement within stipulated turnaround time
- Attending training on self-development course (eg : critical problem solving and emotional intelligence)
- Advise on client enquiries based on SOB and policy wording
- Contribute team work to help other team members to settle cases within SLA
- Assist in RPA and UAT for new projects before going live
- Manage TPA in terms of payment process, claims assessment and client enquiry
- Prepare test scripts for new projects
- Ongoing coaching program and selected for culture ambassador for highly motivating working environment
- Assist in monthly claims utilization reporting and SLA reporting
- Assess cases for admission and discharge from hospitals
- To handle client calls in non-Guarantee cases
- To evaluate the necessary diagnosis and treatment given to patients according to diagnosis
- Review claims guidelines with TPA.
- Provide documents as per request from auditor.
Case Management Senior Executive
Asia Assistance Network Sdn.Bhd
07.2013 - 12.2021
- Handle monthly client TAT/SLA to meet target on admission and discharge GL issuance time
- Assess admission and discharge cases from juniors and guide them accordingly on the assessment done
- Handle client complaints via email and salvage over guaranteed cases and assist on client requirement from time to time
- Main PIC handle for Lonpac and Archipelago client and update guideline accordingly
- Assess variance medical enquiry as per MMA 13th schedule and justify surgical procedure accordingly
- Handle and response to client email on complaints and other enquiries related to policy and claims
Mediclaim assistant
Crescent Solution
04.2011 - 06.2013
- Assess cases for admission and discharges from hospital
- To relate the necessity of the diagnosis with investigations and treatment done
- Promoted to Team Leader (supervisor) within a year working
- Manage staff timetable and man power for the day
Medical Laboratory Technologist
Pantai Premier Pathology
10.2008 - 11.2010
- Worked in Hematology, Biochemistry and Phlebotomist sections
- Undergo training for RXL Siemens Biochemistry machine
- Done blood transfusion and crossmatch in Blood Bank
- Exposed to Advia Hematology machine
- Worked in Hematology, Biochemistry and Blood Bank department
- Undergo training for Cobas Biochemistry machine
- Participated in Blood Bank RCPA
- Done phlebotomist for blood donation in Blood Bank
- Joined the mobile team for blood donation campaign
Education
MASTERS IN BUSINESS ADMIN (MBA) ONGOING - Management
Management And Science University
BSc - Biomedical Science
Management and Science University
DIPLOMA IN MEDICAL LABORATORY TECHNOLOGIST - Medical Laboratory Technology
Kolej PTPL
S.P.M - undefined
Sekolah Menengah Perempuan Raja Zarina
Skills
- Take Ownership of Tasks
- Quick Learner
- Effective Communication
- Adaptable Learner
- Fluent in Spoken & written English
- Fluent in Spoken & written Malay
- Highly motivated
- Interpersonal skills
- Minimum supervision
- MS EXCEL
- MS OUTLOOK
- MS POWERPOINT
- MS PUBLISHER
- MS TEAMS
- MS WORD
- Performance driven
- Quality work
- Reading
- Result oriented
- Self-confidence
- Team-oriented
- Commitment To Continuous Learning
Volunteering And Leadership
- Assunta Hospital, Blood Donation Campaign, 01/2008, 01/2009
- Sekolah Menengah Raja Zarina, Astronomy Club Member, 01/2002, 01/2003
- Management and Science University, Committee Member, COMMITTEE FOR ORGANIZING THE KING OF SLIDE COMPETITION
Awards And Scholarships
- DEAN LIST AWARD, Management and Science University
- QUALIFIED PARAMEDIC, St. John Ambulance
Timeline
Senior Executive- Claims Operation
MCIS Life HQ
12.2021 - Current
Case Management Senior Executive
Asia Assistance Network Sdn.Bhd
07.2013 - 12.2021
Mediclaim assistant
Crescent Solution
04.2011 - 06.2013
Medical Laboratory Technologist
Pantai Premier Pathology
10.2008 - 11.2010
BSc - Biomedical Science
Management and Science University
DIPLOMA IN MEDICAL LABORATORY TECHNOLOGIST - Medical Laboratory Technology
Kolej PTPL
S.P.M - undefined
Sekolah Menengah Perempuan Raja Zarina
MASTERS IN BUSINESS ADMIN (MBA) ONGOING - Management
Management And Science University
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