Dr.Swapnali Palse B.A.M.S.
Thane
Summary
- Results-driven healthcare professional with 4 years of experience in reimbursement claim processing at Aditya Birla Health Insurance.
- Demonstrated success in optimizing operational efficiency through process automation and strategic team collaboration.
- Expertise in analytical problem-solving, regulatory compliance, and accurate claims management, with a strong focus on enhancing client satisfaction.
- Adaptable, proactive, and adept at thriving in fast-paced corporate environments.
- Strong interpersonal and communication skills, combined with a commitment to continuous learning and organizational growth.
Overview
13
13
years of professional experience
Work History
Reimbursement Claim Processing
Aditya Birla Health Insurance Company
04.2021 - Current
- Currently working as Deputy Manager and handling Reimbursement claim processing for DRM customers
- Managed and monitored the claims pipeline- within TAT,Operational Efficiency while maintaining Process Quality.
- Worked closely with cross-functional teams to manage escalations effectively, driving timely resolutions and strengthening interdepartmental collaboration.
- Experience in Claim Analysis of DRM Customers to prevent re-admissions.
- Automation of OPD (Outpatient Department) claims processing to improve efficiency and accuracy-ongoing project.
RMO (Ward In-charge) & TPA Dept.
THANE HEALTH CARE HOSPITAL
02.2012 - 06.2019
- Maintained medical records accurately, ensuring proper documentation for future reference and continuity of care.
- Collected information about patient histories, current conditions and vital statistics to make accurate determinations about conditions.
- Provided routine and emergency medical care to patients.
- Experience of handling patients independently in ward and casualty.
- Handled Post OP Surgical and Ortho Cases
Assistant Doctor
DR. SUPARNA NIRGUDKAR CLINIC
03.2015 - 10.2016
• Assisted in handling OPD patients
Education
BACHELOR OF AYURVEDIC MEDICINE& SURGERY - Ayurvedic Medicine
DR.D.Y. PATIL COLLEGE OF AYURVED
Navi Mumbai12-2010
HSC - Higher Secondary Certificate (HSC)
K. J. Somaiya College of Science And Commerce, Mum
Mumbai03-2006
SSC -
Navodaya English High School, Thane
Thane06-2004
Skills
- Adaptability & Growth Mindset
- Customer-Centric Skills
- Interpersonal Skills
- Conflict Resolution
- Leadership skills
- Problem-Solving & Critical Thinking
- Agility
- Work Ethic & Professionalism
Accomplishments
- Received Rancho Award in 1st Quarter of FY 23-24 for outstanding performance.
- Received appreciation from CEO for re-engaging a customer with ABHI after he considered porting owing to a significant increase in the premium.
- Facilitated seamless cashless claim processing for customers, enhancing their overall experience and reducing claim-related grievances.
- Proactively educated clients on policy benefits, improving their understanding and minimizing potential issues.
- Recognized with positive customer testimonials for delivering exceptional service and support throughout the claims process.
Timeline
Reimbursement Claim Processing
Aditya Birla Health Insurance Company
04.2021 - Current
Assistant Doctor
DR. SUPARNA NIRGUDKAR CLINIC
03.2015 - 10.2016
RMO (Ward In-charge) & TPA Dept.
THANE HEALTH CARE HOSPITAL
02.2012 - 06.2019
BACHELOR OF AYURVEDIC MEDICINE& SURGERY - Ayurvedic Medicine
DR.D.Y. PATIL COLLEGE OF AYURVED
HSC - Higher Secondary Certificate (HSC)
K. J. Somaiya College of Science And Commerce, Mum
SSC -
Navodaya English High School, Thane
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