Neeraj Shyam
Toronto,Canada
Summary
Dynamic healthcare professional and claims specialist with over 13 years of international experience, skilled in enhancing healthcare outcomes while controlling costs. Proven ability to drive strategic improvements across healthcare and insurance sectors, with a robust foundation in Canadian and international medical and disability case management practices. Recognized for delivering high-quality patient care, managing healthcare fraud, and ensuring compliance with healthcare regulations. Extensive expertise in medical claims, disability case management, and managed care, complemented by strong leadership in team supervision and regulatory compliance.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Pre-authorization Manager
Bupa Global
03.2022 - 10.2024
- Led a team of 21 clinical staff and 4 support agents, processing an average of 700 authorization requests daily, with a commitment to efficient and accurate approvals
- Developed and refined policies to enhance patient and client experience, proactively identifying areas for improvement in coordination with stakeholders
- Ensured regulatory compliance in pre-authorization processes, analyzing data trends to streamline workflows and reduce delays in patient care, earning six Customer Champion Awards
- Addressed sensitive escalations and resolved regulator complaints with professionalism, optimizing the customer journey by coordinating between claims, network, underwriting, and call center functions
Case Management Team Lead
Metlife
05.2015 - 02.2022
- Directed a team of eight Case Managers, overseeing 500 patients annually in comprehensive, patient-centered care plans, including home care and specialized treatment coordination
- Managed logistics for medical equipment, nursing, and telemedicine, maintaining compliance with key performance indicators and regulatory standards
- Served as a consultant for Life and Disability claim evaluations, conducting field investigations to support claim adjudications and fraud prevention
- Established relationships with government authorities and healthcare entities, ensuring compliance and minimizing risks related to fraud, waste, and abuse in medical claims
Operations & Marketing Manager
Emergency Care Training Center
01.2014 - 02.2015
- Company Overview: AHA-affiliated training center
- Managed daily operations at an American Heart Association (AHA)-affiliated training center, overseeing instructor training and developing educational content
- Led a team to deliver instructor training to over 300 healthcare professionals annually through workshops, ensuring adherence to AHA standards
- AHA-affiliated training center
Operations & PR Executive
Sultan Al Olama Medical Center
09.2012 - 08.2013
- Contributed to community health initiatives and corporate wellness programs, including Dubai’s 'Your Weight in Gold' campaign
· Conducted performance evaluation of Healthcare Providers at the Clinic & created Quality Reports
· Organized Community Initiatives & Wellness Camps for Corporate and Public Welfare
· Participated in local Medical research projects & research study content creation for the clinic doctor educator teams
Administrative Manager (OHS Officer)
Red Marble Co.
03.2011 - 07.2012
- Focused on occupational health and safety (OHS) compliance within the organization
Medical Doctor
Bombay Hospital
08.2008 - 01.2011
- Delivered clinical care, diagnostics, and treatment in a high-volume hospital setting
Education
MBA - Healthcare Management
Manipal University
01.2017
MBBS - Medicine
International University of Health Sciences
01.2010
Skills
-
Healthcare Case Management
- Expertise in managing complex cases, including chronic disease and high-cost medication management, with a focus on improving patient outcomes and reducing costs Medical Claims Processing and Adjudication
- In-depth knowledge of claims assessment, adjudication, and fraud detection in healthcare insurance, ensuring compliance and efficiency in claims handling Patient-Centered Care Coordination
- Skilled in designing and overseeing patient care plans, liaising with patients, families, and healthcare providers to ensure holistic and effective care Regulatory Compliance and Quality Assurance
- Proficient in ensuring healthcare and insurance operations comply with local, national, and international regulations, including data privacy and patient safety standards Team Leadership and Staff Development
- Proven ability to lead diverse teams, providing guidance, training, and support to drive continuous professional growth and enhance service delivery
-
Process Improvement and Operational Efficiency
- Experience in developing and implementing process improvements in healthcare operations to streamline workflows, reduce costs, and improve the patient experience Data Analysis and Reporting
- Proficiency in analyzing healthcare utilization data to identify trends, optimize resource allocation, and improve organizational decision-making Customer Relationship Management
- Skilled in managing escalations and fostering positive relationships with clients, stakeholders, and regulatory bodies to ensure satisfaction and resolve issues effectively Health Information Management and Medical Coding
- Certified knowledge of medical coding standards (eg, CPC) and health information management, ensuring accuracy and compliance in documentation Program Development and Implementation
- Ability to design and execute innovative healthcare programs, such as chronic disease management and preventive care initiatives, with demonstrated impact on cost savings and quality of care
Academicsandcredentials
- MBA - Healthcare Management, Manipal University, Dubai, 2015-2017
- MBBS - Medicine, International University of Health Sciences, St. Kitts & Nevis, 2010
Certification
- Fellow, Life Management Institute (FLMI), 2021
- Certified Professional in Coding (CPC), 2017
- AHA Instructor Certifications in First Aid, CPR, BLS, ACLS, EMST, 2014
Significantaccomplishments
- Led as Department Head and primary escalation contact, addressing medical and disability claims issues from clients, brokers, and healthcare providers, ensuring effective conflict resolution aligned with industry standards.
- Pioneered a High-Cost Medication and Chronic Disease Management Program, generating annual savings of over USD 350k, with a focus on sustainable and patient-centered care.
- Managed the care of 1,500 insured patients, achieving an annual utilization reduction of USD 3.25 million by implementing targeted case management interventions.
- Collaborated with IT to develop a software tool identifying patterns in healthcare abuse and fraud, saving over USD 2 million annually through data-driven insights.
- Honored with multiple international awards, including Employee of the Year and Global Innovation Awards, for consistently exceeding performance benchmarks.
Languages
English
Native or Bilingual
Urdu
Native or Bilingual
Timeline
Pre-authorization Manager
Bupa Global
03.2022 - 10.2024
Case Management Team Lead
Metlife
05.2015 - 02.2022
Operations & Marketing Manager
Emergency Care Training Center
01.2014 - 02.2015
Operations & PR Executive
Sultan Al Olama Medical Center
09.2012 - 08.2013
Administrative Manager (OHS Officer)
Red Marble Co.
03.2011 - 07.2012
Medical Doctor
Bombay Hospital
08.2008 - 01.2011
MBBS - Medicine
International University of Health Sciences
MBA - Healthcare Management
Manipal University
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