Summary
Overview
Work History
Education
Skills
Timeline
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Ruchi Goel

Ascot Vale,Australia

Summary

I am a dedicated and result oriented operator, having worked in the insurance field for the last couple of years as Customer Service Officer. Hence looking for improvement and better position that could bring stability to my career. I am a quick learner and have an innovative edge which has always been commended by my team and management. Always looking forward for new changes that enhance my knowledge of learning.

Overview

12
12
years of professional experience

Work History

HPAT – Consultant

Medibank Private
06.2016 - Current
  • Accountable for meeting and exceeding set targets and objectives.
  • Have in-depth understanding of particular needs and expectations of our health providers in the insurance industry.
  • Reassessing claims while adjustments are required to be made with Medicare.
  • Checking hospital claims and eligibility, as and when required.
  • Update provider records on internal software applications like iMed, Oscar, WHICS, Genero and MPL intranet.
  • Ensure all enquires are responded to in accordance to their policy and meet Medibank requirements
  • Sending and receiving communications from providers in relation to their queries and issues.
  • Completed hospital quotes and reassessed claims
  • Was on Secondment as Coach – helped team in skilling, coaching and working on complaint cases
  • Built rapport with hospital providers
  • Developed and implemented tailored, performance-based training programs for Customer Claims Support staff
  • Conducted training on the IMED system and interpretation of customer data to create operational excellence within the claims processing teams
  • Provided coaching support to the entire Claims Support floor to ensure consistent achievement of quality and productivity targets
  • Also helping the Claims team in Audit whenever we are not busy as its one team
  • Managed corrections and escalations queues to resolve customer issues swiftly
  • Maintained updates with the team on Max and Frontline communications
  • Receiver of Excellence in Customer Centric Focus Award
  • Achieved above par in Quality for over 3 months
  • Achieved above par in productivity continuously

Ops Consultant – OSHC

Medibank Private
08.2022 - 03.2024
  • Handle all member details and information in a confidential and sensitive manner
  • Processing Medical, Outpatient Hospital, Ambulance and pharmacy claim in WHICS
  • Knowledge and understanding of the health insurance industry
  • Following up on any missing information from members in regards with a claim keeping the claim within the SLA
  • Achieved 100% in Quality for over 3 months
  • Achieved 100% in productivity continuously

Ops Consultant – Claims

Medibank Private
01.2014 - 06.2016
  • Maintain current knowledge of codes of health Industry when processing different types of claims
  • Processing Ancillary Edit , Audit and escalation claims
  • Have in-depth understanding of needs and expectations of our members and health providers in the insurance industry.
  • Run reports on mainframe for operational data
  • Update member records on internal software applications like iMed, R1 and MPL intranet.
  • Ensure all claims are in accordance to their policy and meet Medibank requirements Assessing the Claim Document against the checklist and working out the eligibility of the members’ claim with the covered policy.
  • Finalize claims at the ‘first point of contact’ to provide excellent customer service.
  • Sending and receiving communications from members in relation to their claims.
  • Achieved 100% in Quality for over 3 months
  • Achieved 100% in productivity continuously
  • Delegated authority to approve air ambulance claims as per Medibank policy.
  • Train new starters and mentor them during their initial period
  • Assist Team leader in conducting quality assessments
  • Point of contact duties

Education

Bachelor's in Commerce -

Calcutta University
India
04-2005

Skills

  • Problem-solving
  • Attention to detail
  • Team leadership & development
  • Client relationships
  • Quality assurance
  • Process improvement
  • Active listening
  • Training and development

Timeline

Ops Consultant – OSHC

Medibank Private
08.2022 - 03.2024

HPAT – Consultant

Medibank Private
06.2016 - Current

Ops Consultant – Claims

Medibank Private
01.2014 - 06.2016

Bachelor's in Commerce -

Calcutta University

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Ruchi Goel