Vinoshini Balakrishnan
Senior Medical Claim Executive
Shah Alam
Summary
Dedicated and detail-oriented insurance claims professional with a strong track record in assessing complex inpatient and life insurance claims in line with policy terms and regulatory requirements. Demonstrated expertise in handling a wide range of claims including compassionate allowance, cancer, dialysis, accidental, and critical illness (CI) with integrity, sensitivity, and professionalism. Skilled in performing internal quality audits, identifying potential fraud, ensuring document completeness, and contributing to continuous process improvements. Committed to maintaining high standards of accuracy and compliance to support the financial health of the claims portfolio.
Overview
8
8
years of professional experience
3
3
Languages
Work History
Senior Medical Claims Analyst
Micares Sdn Bhd
03.2022 - Current
- Ensured timely processing of medical claims by junior assessors within the defined turnaround time (TAT).
- Responded promptly and effectively to claim-related inquiries, feedback, and customer complaints, ensuring high levels of service and satisfaction.
- Coordinated with internal and external stakeholders to obtain necessary supporting documents for accurate claim assessments.
- Identified and escalated potential fraudulent cases to supervisors for further investigation.
- Conducted internal quality checks on reimbursement claims processed by peers to ensure compliance with company policies and accuracy in payouts.
- Assessed complex inpatient and life insurance claims, including critical illness, cancer, dialysis, pre/post-hospitalization, and accidental claims.
- Maintained a high level of professionalism and empathy while managing sensitive and high-value claims.
- Contributed to process improvements by identifying gaps and suggesting enhancements to streamline claim workflows.
- Ensured all claim approvals met internal standards and regulatory compliance, safeguarding the organization’s financial interests.
Senior Medical Claim Executive
Eximius Medical Administration Solutions
10.2021 - 02.2022
- Executed timely handling of medical claims ensuring adherence to established guidelines.
- Evaluated reimbursement requests from clients, insurers, and individual claimants.
- Approve and process Hospital & Non - Hospitals claims
- To support in General Practitioner (GP) claims approval, if needed
- To assist billing team in scanning & upload documentation in office system
- To perform any ad hoc tasks assigned by the superior
- To investigate potential fraudulent claims and report any suspicion of an irregularity to the superior
- To attend to claims enquire and correspondences relating to feedback or complaints promptly and effectively
- To follow and ensure all the request for supporting documents and information relevant to the assessment of claim obtain from clients
Claim Assesor
QBE Insurance (M) Bhd
08.2021 - 09.2021
- Managed outpatient claims in Singapore, ensuring registration, processing and adjudication within specified turnaround times.
- Monitor and follow-up on unsettled claims promptly
- Handle claims assigned independently
- Handling with client and agents in proper manner
- Process per-approval requests in accordance with required benchmarks
- Evaluate and gather all data for claim / underwriting processes, prepare medical questionnaire and to review all status and ensure efficient adjustment in claim / underwriting system
- Ensure meeting individual quality, turnaround time and productivity benchmark
- Effective assessment of how the enhancement will affect claims / underwriting operation efficiency
- Suggest and implement workarounds before and after system implementation
Claim Executive
MiCare Sdn Bhd (a member of Zuellig Pharma Group)
01.2019 - 07.2021
- Processed medical claims efficiently within designated turnaround time in compliance with claims protocol.
- To attend to claims enquirers and correspondences relating to feedback or complaint promptly and effectively
- Secured necessary documentation and details from clients in a timely manner for thorough claim evaluations.
- To investigate potential fraudulent claims and report any suspicion of an irregularity to the superior
- To perform any ad hoc tasks assigned by the superior
CLINICAL LABORATORY SCIENTIST (INTERNSHIP)
KPJ SENTOSA KL SPECIALIST HOSPITAL
01.2018 - 07.2018
- Matched computer orders with specimen labeling for organized work.
- Ensured quality outcomes through standards, controls, and routine equipment maintenance.
- Acted as a technical resource by engaging in staff training.
- Identifies and communicates abnormal patient conditions by alerting supervisory personnel, the pathologist, the patient physician, or nurse, reporting mandated information to the public health department or other designated officials
- Delivered diagnostic and treatment information by utilizing specialized biochemistry machinery such as Roche-cobas 6000 analyzers.
- (Hematology) provides test results for patient diagnosis and treatment by operating hematology, and coagulation equipment, performing manual methods of differentials
- Performed technical procedures to identify bacteria, parasites, fungi, and microbacteria.
Education
Master of Business Studies/Administration/Management - Business Administration
Asia E University
Bachelor of Medical Science - Biomedical Science
University College of Science and Technology
Biomedical Foundation Diploma - Life Sciences
City University Malaysia
Skills
Scientific Research
Timeline
Senior Medical Claims Analyst
Micares Sdn Bhd
03.2022 - Current
Senior Medical Claim Executive
Eximius Medical Administration Solutions
10.2021 - 02.2022
Claim Assesor
QBE Insurance (M) Bhd
08.2021 - 09.2021
Claim Executive
MiCare Sdn Bhd (a member of Zuellig Pharma Group)
01.2019 - 07.2021
CLINICAL LABORATORY SCIENTIST (INTERNSHIP)
KPJ SENTOSA KL SPECIALIST HOSPITAL
01.2018 - 07.2018
Master of Business Studies/Administration/Management - Business Administration
Asia E University
Bachelor of Medical Science - Biomedical Science
University College of Science and Technology
Biomedical Foundation Diploma - Life Sciences
City University Malaysia
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