Deepanshu Mehra

Experienced Claims & Fraud Control Professional with 8+ years of expertise in Health Insurance Claims Management, Fraud Investigation, Risk Mitigation, Cashless & Reimbursement Claims Processing, Legal Claims Handling, and Team Leadership. Proven track record in fraud identification, process improvement, claim audits, and operational excellence. Skilled in managing investigation teams, claim adjudication, and driving quality outcomes while ensuring compliance with policy guidelines.

Manager FCU Claims - Good Health Service

(2025-06)

• Handles a team of 8 members along with freelancing investigator.
• Assigned daily tasks to team members and Freelance investigator for case investigation and trying to identify fraud or nexus establishment.
• Assigned field verification claims to Doctor's for report making
• Process and maintain report of team performance as per assign task.
• Verify the hospital tariff and medicine purchase invoice along with doctor registration certificate
• Reading & understanding the reimbursement & cashless claim related diagnosis (Medical Terms).
• Documents transactions by completing forms and recording logs.
• Maintains quality service by following organization standards.
• Also know about hospital background which was fraud/Hiding the facts.
• Cross check during the processing claims document Manipulation/MOF facts

Deputy Manager - HDFC ERGO GENERAL INSURANCE

(2019-09 - 2025-06)

• Handing all types of claims / Grievance / Customer VOC / Claim Audits / Claims Review / Recovery / Fraud & Mis-representation Identification / Duplicate Identification / Legal claims / Benefits claims / Pre-auth / PA claims.
• Well Knowledge of product as per policy term & condition.
• Processing the cashless & reimbursement cases in the TAT.
• Analyzing claims with history and past preference for customizing claims standards.
• Query resolution as reported on claims query business ID.
• Preparing daily reports
• Monitoring team activity as per assigning task.
• Implementing activities during the processing error.
• Follow the details billing step and billings check list.
• Analysis of claims regarding the feasibility of claims with regards to policy conditions.

Executive of Health Claims Processing - SPECTRUM TALENT MANAGEMENT (P) LTD

(2019-12 - 2021-06)

• Processing the cashless & reimbursement cases in the TAT.
• Analyzing claims with history and past preference for customizing claims standards.
• Query resolution as reported on claims query business ID.
• Preparing daily reports
• Monitoring team activity as per assigning task.
• Implementing activities during the processing error.
• Resolve billing and process.

Senior Executive of Risk & Loss Mitigation - ICG SERVICES

(2017-04 - 2019-07)

Handing all types of claims & investigating process as well of Apollo Munich Insurance Co.

• Handles a team of 10 members.
• Process and maintain report of team performance as per assign task.
• Verify the hospital tariff and medicine purchase invoice along with doctor registration certificate
• Reading & understanding the reimbursement & cashless claim related diagnosis (Medical Terms).
• Documents transactions by completing forms and recording logs.
• Maintains quality service by following organization standards.
• Also know about hospital background which was fraud/Hiding the facts.
• Cross check during the processing claims document Manipulation/MOF facts.
• Resolve billing and process.

Bachelor of Arts - D.U (2016)

12th - C.B.S.E. Board (2012)

10th - C.B.S.E. Board (2010)