Kalnisha Velu

Quality Analysis and Resolution:

• Performed root cause analysis to identify and resolve quality issues and defects.
• Conducted risk assessments to identify and mitigate potential quality issues.
• Investigated customer complaints and executed corrective actions for resolution.

Quality Assurance Monitoring and Compliance:

• Assessed performance quality by monitoring quality assurance metrics, reports, and dashboards.
• Conducted process and system audits to identify areas of improvement and enforce compliance with industry standards.
• Designed and executed robust quality assurance strategies, aligning our performance metrics seamlessly with both regulatory requirements and industry best practices.

Collaboration and Process Improvement:

• Collaborated with cross-functional teams to develop and implement process and system improvements.
• Collaborated closely with senior management to strategise, develop, and implement technical initiatives in alignment with the organization's strategic objectives and vision.
• Oversaw the development and implementation of improvements in support and network operations.
• Implemented new quality assurance and customer service standards.
• Monitored staff organization, suggesting enhancements for daily functionality.
• Ensured consistent production quality by implementing and enforcing automated practice systems.

Quality Assurance and Compliance Expertise:

• Monitored activities and systems, identifying weak areas and implementing corrective methods to ensure strict compliance with regulations.
• Conducted evaluations, streamlined processes, and utilized comprehensive quality assurance analysis to enhance overall performance standards.

Best Practices Development and Implementation:

• Specialized in developing and implementing Best Practices (BP) programs across diverse business lines, ensuring consistent achievement of quality standards benchmarks.
• Crafted and implemented QA policies and procedures aligned with organizational objectives, fostering a culture of quality excellence.

Training and Operational Enhancement:

• Delivered comprehensive training and support to QA reviewers in various Asian offices, covering systems, policies, procedures, and core processes. Ensured seamless operations and strict adherence to quality standards.
• Assumed key responsibilities in onboarding new Third-Party Administrator (TPA) clients. Managed assimilation, documentation, and execution of new TPA processes, fostering operational excellence, customer satisfaction, and substantial business growth.

Claims Management:

• Specialized in third-party administration of A&H claims, managing corporate claims underwritten by our clients across Asia.
• Reviewed police reports, medical records, travel documents etc. determining liability accurately.
• Prepared monthly reconciliation reports and invoices, ensuring accuracy and financial integrity.
• Identified and flagged potentially fraudulent claims, enhancing client trust and minimizing risks.
• Collaborated with Client-appointed loss adjusters for efficient on-site investigations.

Stakeholder Collaboration:

• Facilitated claims correspondence, ensuring clear communication with all stakeholders.
• Customized claims system platform in collaboration with IT specialists, optimizing operations.

Data Analysis and Reporting:

• Designed questionnaires and templates for efficient data collection and analysis.
• Compiled customized presentation materials for regional meetings, enhancing brand representation.
• Analyzed gathered information to report findings and provide actionable recommendations.

System Onboarding and Optimization:

• Led onboarding efforts for new claims system, collaborating closely with System Implementation Lead and Developers.
• Ensured smooth system operation by conducting rigorous testing in UAT and Production environments.
• Collaborated with Business Analysts to extract data and construct tailored reports for business needs.
• Provided comprehensive training to claims team, including workarounds for developing or fixing features.
• Enhanced and developed the system for live TPA accounts, onboarded new TPA accounts, and performed ongoing sprint tests and bug reports.

Effective Communication and Team Collaboration:

• Regularly updated claims team on new developments and fixes, ensuring they were well-informed of any impacting changes.

H&S Claims Adjudication:

• Independently evaluated and processed minor medical claims, issuing pre-authorizations, top-up, and final authorization letters within time-sensitive constraints.
• Reviewed and countersigned escalated claims, providing expert guidance on interpreting medical reports to ensure accurate assessment.
• Identified claims needing further investigation or queries, escalating them to appropriate departments for comprehensive coverage or liability resolution.

Medical Claims Adjudication Specialist:

• Conducted precise desktop assessments and adjudicated diverse medical claims, including hospitalization, pre- and post-hospitalisation, emergency accident treatment, outpatient cancer, and kidney treatments.
• Processed payments for various cash benefit claims, including daily hospital income and surgical benefits, ensuring accuracy and timeliness.
• Designed customized medical questionnaires to gather essential patient medical histories, enhancing the information gathering process.
• Diligently reviewed all claims, promptly identifying and escalating potentially fraudulent or suspicious cases for thorough investigation.
• Collaborated closely with section head and adeptly managed ad-hoc tasks, ensuring efficient and accurate claims processing.