Dr Siva Kumar

IMMEDIATE JOINER- Experienced Senior Manager specializing in Health Claim Processing and Health Investigation with over 7 years of expertise. Proven track record in leading end-to-end claim management, investigating medical documents, identifying fraudulent claims, and ensuring compliance with healthcare regulations. Adept at process optimization, team leadership, and minimizing financial losses through rigorous verification and internal controls.

Committed to maintaining data accuracy, operational efficiency, and integrity in healthcare services.

Senior Manager at ICICI Lombard (2025-08 – 2026-05)

• Led health investigation initiatives focusing on internal controls and loss minimization, enhancing operational efficiency.
• Allocated cases effectively between vendors and internal teams, ensuring timely closure within established turnaround times.
• Provided expert medical opinions that identified numerous discrepancies in claim processing, improving claim accuracy.
• Scrutinized and rejected fraudulent claims, reducing financial losses and safeguarding organizational assets.
• Reported non-compliant hospitals to the triage team, recommending deempanelment to maintain network integrity.
• Detected bill inflation, resulting in cost savings of several lakhs INR for the organization.
• Supported and motivated the team during high-pressure periods, maintaining productivity and morale.

Deputy Manager at Star Health Insurance (2019-12 – 2025-07)

• Identified the genuineness of assigned claims, scrutinizing misinterpretations and undisclosed pre-existing conditions.
• Conducted physical and telephonic verification of patient health claims and conditions for genuineness assessment.
• Maintained close association with network hospitals and canvassed non-network providers to expand coverage.
• Leveraged 8+ years of experience in clinical services and integrated dental care delivery for effective claim management.

Dental Surgeon at R.K Dental Clinic (2014-11 – 2022-11)

• Managed private dental practice, providing comprehensive dental care services to patients.
• Ensured high standards of patient care and treatment accuracy in a private clinical setting.

BDS – Pondicherry University (2012)

XIIth in English (2007)

Xth in English (2005)