Nishant Upadhyay
Nadiad
Summary
Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Group- Head -Insurance & TPA
Bankers Heart Institute
04.2022 - Current
- Overall heading to Insurance & TPA Department for Bankers Group – Branches at , O P Road, Warasia, Manjalpur & Surat
- Insurance & TPA Empanelment, New Tie ups for IPD & OPD Services
- International TPA- Empanelment, & International Patient management
- Complete responsibility for Health Check up all the branches of Bankers and overall operational activity for OPD staffs
- Overall responsibility for Payment recovery (Collections)
- Interacting with Team, for smooth processing of OPD & IPD services
- Coordination with TPA/ Insurance Company for Approval / Payment of cashless cases
- Keep tracking for Monthly bills submission and payment reconciliation for Credit Company
- Good Command over business communication, Excel, MIS
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Strengthened communication skills through regular interactions with others.
TPA- Head
Bhailal Amin General Hospital
10.2020 - 04.2022
- Overall heading to TPA Department
- Front Office & Back Office Management
- Estimations of Surgical Patients
- Outstanding follow up for Admitted Patients on daily basis
- Overall responsibility for Collections / payment recovery from TPA/Ins.Co
- Tracking of Dispatch Files
- Pre –Auth Flow Management
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
- Review and follow up for short payment cases and overdue cases
- Patient/ Relative Counseling
- Bill explanation to relative/ patient
- Grievance handling & Resolutions
- Reimbursement cases Queries/ disputes/ grievance handling
- Coordinating with TPA/ Insurance Co
- Team Handling & Team Management
- Coordination with Finance, Operations, Billing Team
- Providing details of payment to Finance Team
- Tracking of Refund payment to patient
TPA- Head
Sterling Hospital
04.2017 - 09.2020
- Overall heading to - TPA department
- Additional Responsibility for MOD (Manager on Duty) – @ Night 4 days in Month taking overall responsibility of hospital, taking care of operational activity for all the departments, Admin, Maintenance, Emergency, Patient care , IPD billing, Insurance, Front Desk management issues and patients complaints etc
- Reporting on regularly next day morning and issues resolution
- Payment collection responsibility MIS for outstanding – as well as multi & Cancer Unit
- Daily Files tracking for submission to tpa
- Outstanding follow up, pending payments collections, deductions issues
- Pre-auth related issues, & final settlements
- Overall settlements of corporate/ TPA/ MA Yojana / PMJY etc in system
- Tracking of non-recoverable payments/ rejections/ reconsideration cases with insurance company/ tpa
- Health checkup bills tracking and collection updates / settlement responsibility
- Patient’s relative counseling for any dispute/deduction / settlement related issues
- Overall team handling 7 people
- Experience of Tpa empanelment / tripartite agreements for multi & onco unit
- In-charge of Sterling Cancer Hospital, Bhayali – TPA empanelment / Billing
- Overall team strength of 2 people handling for tpa empanelment, collection, refund , settlements including corporate & government
Manager- Marketing
Radha Multispeciality Hospital
05.2015 - 03.2017
- Marketing Strategies:
- Retaining existing business while developing new opportunities
- Target immediate business from doctors, GPs, and ambulances
- Increase revenue through direct patient engagement
- Focus on ICU and surgical patients
- Conduct monthly marketing reviews and analyses
- Cultivate relationships with doctors through regular meetings with specialists, super specialists, and general practitioners
- Cover major doctors in Baroda and surrounding areas
- Areas served include Baroda local, Bodeli, Rajpipla, Dabhoi, Waghodia, Karjan, Por, Savli, and nearby villages.CME with Doctors association & group of doctors - Doctors Meet – Baroda Doctors Group
CME with Dabhoi Doctors Association
Doctors Dinner Meet – IMA Waghodia
TPA Empanelment - Responsible for Insurance & TPA empanelment, corporate empanelment, and wellness partnerships.
- Empanelment of Corporate
- Apollo Tyres, L&T, ICICI Bank, FedEx, and LIC of India have initiated their health checkup processes, along with VMC empanelment. The Airport Authority of India and regular visits to leading GIDC companies for CSR activities are also underway.
- Medical Camp Activities:
- Camps in local societies, villages, and in-house hospital
- Branding and advertising for the hospital
- Distribution of leaflets for specialized mega camps, as well as newspaper ads, hoardings, and small banners
Dy.Mgr. Sales & Marketing
Salya Medical Institute (Mgmt. of Pure Health Hospital)
08.2014 - 05.2015
- Overall responsibility for Insurance & TPA empanelment, Corporate tieups
- Empanelment of Leading TPA’s
- Empanelment of Top Corporates
- TUFLEX, Amcore flexiables , Gujarat Fibers , Bell Ceramic, Videocon, Gujarat Steelco Ltd
- Reliance Industries, Aditya Birla Industries
- GIDC mapping
- Palej & Bharuj GIDC mapping
- Dahej GIDC, Phase- I, II & III & Exploring new corporate
- Dahej GIDC Corporates
- Indobegin , DIC Fine Chem, Torrent Power, Gujarat State Petronet, OPEL, Reliance Industries, Aditya Birla, Pidilite , Meghmani Industries etc
- Own Medical Center Started in GIDC –Phase I @ Dahej
- Rural Camp Activities
- Valan, Kamboli, Palej, Por GIDC etc
- Doctors contacts
- Palej, Karjan, Por etc
Sr.Executive- Credit Business
Sterling Hospital
03.2012 - 08.2014
- Manage insurance and TPA empanelment, payment collections, and MIS preparation for credit company bill submissions and settlements.
Oversee TPA empanelment documentation, including tracking MOUs for renewals and new partnerships in Rajkot, Bhavnagar, Mundra, and Adipur.
Monitor TPA and corporate documents, file submissions, and responses to TPA queries.
Follow up on cashless payment files, manage outstanding payments with TPA/corporates, and prepare collection reports for management.
Address cashless grievances and set monthly collection targets for corporate/TPA clients, including BSNL, ESIC-Bapunagar, ONGC, Engineers India Ltd, Swaminarayan Gurukul, IOCL, SBI, and Airport Authority.
Conduct regular visits and meetings with TPAs, insurance companies, and five corporates to discuss outstanding payments, service feedback, and opportunities for patient increases.
Manage branch visits in Rajkot, Bhavnagar, Adipur, and Mundra while overseeing credit control management, ensuring corporate credit business is maintained, and reporting to management.
Support branch TPA outstanding follow-ups.
Operation Incharge
MDIndia Healthcare Services TPA Pvt.Ltd.
12.2006 - 03.2012
- Customer Relationship & Contact Management
Manage front desk operations, address issues from agents and policyholders, handle claims complaints, and maintain relationships with local agents and development officers.
Call Center – Maintain etiquette, record daily calls and complaints, and follow up on claims/issues while responding to clients.
Cultivate relationships with local divisional offices of insurance companies.
Ensure quick responses to customer inquiries and effective problem-solving.
Claims Management
Conduct daily checks on claims documents, handle audits, and update necessary software.
Regularly follow up and escalate matters to headquarters in Pune.
Medical Record Management
Manage documents for in-process, settled, and rejected claims, ensuring proper record-keeping.
Daily Reporting System
Report to Head Office using prescribed formats.
Team Handling
Oversee daily operations of the front desk, call center, and client servicing team, ensuring smooth functioning through effective reporting systems.
Enhance team collaboration through regular communication, feedback loops, and iterative planning sessions.
Insurance Desk executive
National Insurance Company
05.2001 - 12.2006
- Renewal Notice for Policyholders
Premium calculations for Motor, Mediclaim, Fire & Allied, Householder, Personal Accident, OMP, and Group Policies.
Premium collections.
Claims management and follow-up with TPAs/insurance companies across various departments.
Education
Executive Diploma in Business Communications -
Athena Global Education
Introduction to Office and Administrative Management -
Alison
Diploma in Computer Applications -
St' Anne's High School
Diploma in Computer Programming -
Dharamsinh Desai Institute College
Financial Accounting System -
L.C.C.
M.S.Office -
L.C.C.
Master of Commerce Certificate -
I.V.Patel College of Commerce
03.2000
Beachelor of Commerce - Accounts/ tax/ Businesss administration
I.V.Patel College of Commerce
03.1999
High Secondary Certificate -
G.S.E.B
03.1996
School Secondary Certificate -
G.S.E.B
03.1994
Skills
- Startup Experience
- Business Turnaround Strategy
- Rapid Growth Situation
- Proficient in Microsoft Office (Excel, Word, PowerPoint)
- Management Information Systems Expertise
- Different Type of Printers
- Effective Team Collaboration
- Time management
- Multitasking Abilities
- Excellent communication
- Critical thinking
- Organizational skills
- Decision-making
- Troubleshooting Skills
Coursework
- Executive Diploma in Business Communications, Athena Global Education, Three Month
- Introduction to Office and Administrative Management, Alison, Three Month
- Diploma in Computer Applications, St' Anne's High School, Nadiad, One year
- Diploma in Computer Programming, Dharamsinh Desai Institute College, Nadiad, One year
- Financial Accounting System, L.C.C. Nadiad, One month
- M.S.Office, L.C.C. Nadiad, One month
Hobbies and Interests
- Reading Books
- Music
- Painting
- Swimming
- Meditation
Personal Information
- Caste: Hindu Brahmin
- Date of Birth: 01/23/79
- Marital Status: Married
Certification
Certification of Training - Excel
Diploma in Business Communication
Reading Books , Music , Yoga
Motivational and spiritual books, listening to trending songs, and practicing yoga for mental and physical fitness.
Languages
Gujarati, Hindi, English
Native language
Gujarati
Advanced
C1
Hindi
Upper intermediate
B2
English
Intermediate
B1
Marathi
Beginner
A1
Timeline
Group- Head -Insurance & TPA
Bankers Heart Institute
04.2022 - Current
TPA- Head
Bhailal Amin General Hospital
10.2020 - 04.2022
TPA- Head
Sterling Hospital
04.2017 - 09.2020
Manager- Marketing
Radha Multispeciality Hospital
05.2015 - 03.2017
Dy.Mgr. Sales & Marketing
Salya Medical Institute (Mgmt. of Pure Health Hospital)
08.2014 - 05.2015
Sr.Executive- Credit Business
Sterling Hospital
03.2012 - 08.2014
Operation Incharge
MDIndia Healthcare Services TPA Pvt.Ltd.
12.2006 - 03.2012
Insurance Desk executive
National Insurance Company
05.2001 - 12.2006
Introduction to Office and Administrative Management -
Alison
Diploma in Computer Applications -
St' Anne's High School
Diploma in Computer Programming -
Dharamsinh Desai Institute College
Financial Accounting System -
L.C.C.
M.S.Office -
L.C.C.
Master of Commerce Certificate -
I.V.Patel College of Commerce
Beachelor of Commerce - Accounts/ tax/ Businesss administration
I.V.Patel College of Commerce
High Secondary Certificate -
G.S.E.B
Executive Diploma in Business Communications -
Athena Global Education
School Secondary Certificate -
G.S.E.B
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