maneka jhowry

A dedicated healthcare professional with an MBBS degree and 3–4 years of experience in TPA and health insurance claims management. My  work involves clinical scrutiny, hospital coordination, package validation, and ensuring compliance in claim processing.Also i am pursuing MBA in HAHM from Dr DY Patil.which strengthens my understanding of healthcare administration, policy, operations, and quality assurance.

• Managed pre-authorization, claim scrutiny, and cashless approvals for diverse specialties.
• Evaluated clinical documents, diagnostic reports, operative notes, and treatment plans to ensure medical necessity and compliance with scheme guidelines.
• Identified package misuse, overbilling, procedural discrepancies, and raised queries to prevent fraud and financial leakage.
• Coordinated with hospitals, district medical officers, and processing teams to ensure accurate package booking, documentation completeness, and guideline adherence.
• Performed detailed clinical auditing of complex fracture cases, oncology drug invoices/barcodes, and government-reserved categories.
• Ensured seamless communication between stakeholders by drafting high-clarity emails, instructions, and case-related advisories.
• Assisted in field audits/beneficiary audits, contributing to evidence collection and report preparation for submission to state health authorities.

currently working in Vidal Health TPA as a Chief Medical Officer-July 2024
 

MBA in Hospital & Healthcare Management (HAHM) 2024 -2026

MBBS (Bachelor of Medicine & Bachelor of Surgery)-2012 -2018