
Timeline
About me
Medical Adjudicator | Medical Claim Processing | Employee Benefit Claims | PA Claims | Group Policy Claims | Individual Medical Claims | LOG
Education

Politeknik nilai
2013 - 2016Diploma in biotechnologyFirst Class (Gold Medalist)

Universiti malaysia pahang
2017 - 2021B. app sc industrial biotechnology (hons)Second Class (Upper)
Experience

Halex biotechnologies sdn bhd
Mar 2016 - Oct 2016Research associate (internship trainee)I have been excellently trained for under various departments such as Plant Tissue Culture Laboratory, Vermiculture Technology Department, Quality Control & Assurance Department, Marketing Department, and Farming Department. Besides that, I have successfully developed few SOPs for endangered species of ferns, roses, 'Belalai Gajah' and etc as tissue culture projects. I have also contributed the operation team by meeting the daily productivity standard performance and less than 5% of contamination rate. Liaised with the 7 customers for the purchasing procedure and also processed 3 customer complaints on product quantity and quality and reported back to Assistant Manager together with problem solutions, corrective and preventive measures. 1. Assisted in the workflow of various departments such as R&D, QC/QA, Marketing, HR, Farming and Vermiculture Technology.2. QC/QA - Engaged in quality management and control analysis of the products and engaged with customers', resolved complaints by conducting root cause analysis and applied preventive actions to prevent the non-conformance from happening again.3. Marketing - Participated and provided administrative support in several projects for commercialization of the products to local and international customers. Show less

Department of environment
Mar 2021 - Aug 2021Regulatory enforcement officer (internship trainee)I was excellently trained as an enforcement member that inspects factories and premises that are licensed under Environmental Regulations. I also have engaged with the clients regarding legislation applications, processed the applications by performing precise samples analysis obtained from the laboratory and finalized the applications' status via legal documentation and accurate data entry into the system. Apart from that, I have resolved more than 9 customers' complains tactfully and professionally. Not only that, I have also obtained tremendous knowledge on numerous regulation under DOE by attending 1 month training and performed self-learning to increase the learning efficiency and became a competent and beneficial member of the role and company. Maintained the accurate operation on management of scheduled waste data on Electronic Scheduled Wastes Information System (e-SWIS) which was learnt via online training for 2 weeks and supervised the branch e-SWIS efficiency. I have also reflected the client's opinions to the Manager which increased the team performance and efficiency.1. Prepared legal documentation for industries regarding compliance and non-compliance.2. Processed various applications not limited to scheduled wastes disposal, special management of scheduled wastes, open burning and as build plan validation.3. Handled clients' inquiries and requests accurately and professionally.4. Resolved clients' issues and complaints tactfully according to departments procedures. Show less

Integrated health plans sdn bhd
Mar 2022 - Apr 20251. Process and adjudicating 1,000 monthly medical insurance claims with high accuracy.2. Review and validating claims using ICD-10 coding to ensure correct diagnosis mapping and minimize rejections.3. Assist in financial leakage recovery initiatives.4. Assess high-value claims (up to RM450,000), verifying uncovered charges based on policy guidelines.5. Investigate discrepancies in claims, including pre-existing conditions, non-disclosure cases, and potential fraud.6. Liaise with insurers, hospitals, agents, and insured individuals to resolve complex claims.7. Provide expert guidance to call center teams and support urgent case resolution, including after-hours assistance.8. Ensure timely issuance of guarantee letters (GLs) within the determined turnaround time (TAT).9. Liaise with insurers and healthcare providers to verify treatment necessity and coverage limitations. 10. Ensure timely approval or escalation of high-value claims exceeding authority limits. Show less
Medical Adjudicator (Healthcare Unit)
Sept 2022 - Apr 2025Customer Service Officer (Guarantee Letter Team)
Mar 2022 - Aug 2022
Licenses & Certifications
- View certificate

Microbiology laboratory technician
Alison - free online learningSept 2021
Honors & Awards
- Awarded to Maharani MaghalingamDegree Dean's List Award Semester I 2018/2019 Universiti Malaysia Pahang Jan 2019
- Awarded to Maharani MaghalingamExco of Welfare of SCITEXS Universiti Malaysia Pahang Aug 2018 Semester II 2017/2018
- Awarded to Maharani MaghalingamExco of Welfare of SCITEXS Universiti Malaysia Pahang Jan 2018 Semester I 2017/2018
- Awarded to Maharani MaghalingamDiploma in Biotechnology - Gold Medal Award Polteknik Nilai Jun 2017
- Awarded to Maharani MaghalingamParticipation in FAMB 2015 Politeknik Nilai Sep 2015 Researched on the usage and development of rice straw biomass waste to produce biodegradable oil blotting facial sheet which was theoretically proven to reduce 50% of biomass waste and more than 75% of polypropylene.
- Awarded to Maharani MaghalingamBiogenius Invention - 1st Runner Up Politeknik Nilai Dec 2014 Researched on the usage and development of rice straw biomass waste to produce biodegradable oil blotting facial sheet which was theoretically proven to reduce 50% of biomass waste and more than 75% of polypropylene.
- Awarded to Maharani MaghalingamParticipation in BIOCAREER 2014 Ministry of Science, Technology and Innovation Nov 2014
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