Anand Santosh Kale
Pune
Summary
To achieve an opportunity in a reputed organization where I can enhance and utilize my challenging and hardworking capabilities. I aim to develop strong management skills, continuously learn emerging technologies, and apply my knowledge to deliver innovative solutions. I am committed to contributing to the growth of the organization, working effectively in a team environment, and using my skills for the betterment of humanity.
Overview
3
3
years of professional experience
1
1
Certification
Work History
TPA Co-Ordinator
Medworld Solutions Pvt. Ltd.
08.2023 - Current
- Act as the primary liaison between the hospital and insurance companies/TPAs for empanelment agreements.
- Prepare and submit required documents (hospital licenses, certificates, tariff lists, MOUs) to insurance companies for empanelment.
- Coordinate with hospital management and insurance companies to finalize tariffs, package rates, and service inclusions.
- Monitor empanelment renewals, update agreements, and ensure compliance with IRDA and insurance guidelines.
- Build and sustain professional relationships with insurance companies, TPAs, and corporate clients.
- Communicate empanelment updates, package changes, and insurance guidelines to hospital departments.
- Assist during insurance audits by providing empanelment agreements and compliance documents.
Insurance Co-Ordinator
Sawangikar Multispeciality Hospital
05.2022 - 07.2023
- Claim Processing & Documentation
- Handle insurance claims from initiation to settlement by collecting, verifying, and submitting documents.
- Filed and tracked insurance claims and communicated claims status to patients.
- Prepared insurance claims for submission to clearinghouses or insurance companies.
- Verified insurance and communicated coverage to staff and patients.
- Ensure accuracy and compliance with TPA/insurance guidelines to avoid claim rejections.
- Guide patients on insurance coverage, claim procedures, and required documentation.
- Coordinate with Third Party Administrators (TPAs) and insurance companies for pre-authorizations and approvals.
- Work closely with the billing department to ensure accurate claim charges are submitted.
Education
Master of Science - Computer Science
SB College Of Science
Aurangabad, Maharashtra06-2021
Bachelor of Science - Computer Science
MIT College Cidco N-4
Aurangabad, Maharashtra05-2019
HSC -
MIT College Cidco N-4
Aurangabad, Maharashtra05-2015
SSC -
MIT Technical Scool
Aurangabad, Maharashtra04-2013
Skills
- Hard Working – Always ready to give my best and work sincerely
- Quick Learner – Can learn new tasks and adapt to changes quickly
- Client Handling – Good at coordinating and communicating with clients
- Time Management – Can manage tasks and time in the most efficient way
- Trust Building – Listen carefully, speak honestly, and treat others with respect
- Result Oriented – Focus on important work and deliver results on time
- Teamwork – Work well with others and support team goals
- Problem Solving – Able to find simple and effective solutions to challenges
- Communication Skills – Can explain ideas clearly and confidently
- Positive Attitude – Stay motivated and encourage others
Certification
- MS-CIT
- Typing
Language Proficiency
Marathi
Hindi
English
Timeline
TPA Co-Ordinator
Medworld Solutions Pvt. Ltd.
08.2023 - Current
Insurance Co-Ordinator
Sawangikar Multispeciality Hospital
05.2022 - 07.2023
Master of Science - Computer Science
SB College Of Science
Bachelor of Science - Computer Science
MIT College Cidco N-4
HSC -
MIT College Cidco N-4
SSC -
MIT Technical Scool
Hobbies and Interests
Playing And Watching Cricket, Watching TV Shows And Web Series, Travelling, Songs Listening
PERSONAL DETAIL
- Name :- Mr.Anand Santosh Kale
- Gender :- Male
- D.O.B :- 27/12/1997
- Marital status :- Married
- Permanent Address. :- House No. 45, Kharadi - Hadapsar Bypass Rd, near Manipal Hospital, Raghoba Patil Nagar, Santipur, Thite Nagar, Kharadi, Pune, Maharashtra 411014.
Disclaimer
I, hereby affirm that all the information furnished above is true to the best of my knowledge and belief.
PLACE:- Pune, Maharashtra Anand S. Kale
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