Chief Manager - Claims Digital transformation - Star Health Insurance - Chennai
(2024-07 - 2025-10)
- Led digital transformation of claims processing across Matrix and Galaxy – reducing manual intervention by 40%.
- Work flow improvements – Controlling the TAT, creating Wireframes, Data Analysis.
- Tariff digitization – Supporting the different departmental heads, IT, Business teams' coordination for building a platform for digitization.
- UI & UX experience improvements, User interface design based on regulatory compliance.
- ICD analysis and reports – Error free diagnosis and automation of claims processing.
- Requirement gathering & analysis - Vigilance dept. Complete Automation project.
- BRD and FRD created for the business teams and stakeholders based on the requirements.
- Facilitated stakeholder to align business needs with system capabilities, resulting in 3 successful product launches.
- Developed QA checklists and categorized 200+ test cases to support UAT.
- Microsoft Outlook, JIRA, Atlassian, Confluence, Visio, Vitraya, Matrix, Galaxy applications.
Health Claims Management and Core Networking expert - ICICI Lombard GIC - Chennai
(2019-12 - 2024-06)
Quality networking hospitals of 300+ (Chennai), coordination, negotiation, different tariff models created to control ACS. Operations and claims management for effective & efficient processing of claims, leading the auditing teams to ensure proper adjudications and settlements done on time.
- Pricing strategy and Tariff preparations for hospitals – ACS control - Identifying outliers and caution the regional teams of the health portfolio.
- Interactions with top management in the organization to analyse business requirements, processes, and information systems.
- Preparing different costing models and negotiation with the providers – Maintenance of quality network portfolio and also assisting in recovery and FWA.
- Received "Performance Excellence Award" 2023 for achieving the targets and excelling KPIs.
- Project: Provider Tariff Digitalization (Internal product development)
Manager – Operations - Camomile Healthcare Consulting Pvt Ltd
(2016-11 - 2019-11)
- Established the feasibility of public specialty Cancer care centres in the states of KN & TN.
- Development and Implementation of hospital transformation plan for Guwahati SCI.
- Due diligence and consultancy of 300 & 500 bed hospitals in Mumbai, Tirupati & Nigeria
- Development of a hospital compliance report for a large chain of private hospitals in Bangalore
- Proposed HR planning and Medical equipment planning for a 300 bed multispecialty hospital in Tamil Nadu and Assam.
- Conducted a Nation-wide research on "Delayed diagnosis of cancer" as CSR activity
- Supported business development activities and sourcing projects from various clients.
Administrator - Operations - Billroth Hospitals Pvt Ltd
(2014-08 - 2016-11)
- Daily operations of 350 bedded hospital coordinating all 52+ clinical & non clinical departments
- Coordinated primary staff and physician schedules and ensured optimum duty coverage
- Evaluated discharge process delays due to insurance, pharmacy delays and provided suggestions to reduce 45 min TAT
- Supported for internal audits and MIS for operations tracking the data. Empowered staff and patients through transitional changes, communicated objectives and expectations alleviated concerns and ensured procedural adoption
- Awarded "Best-Employee–2015" for being an outstanding performer in hospital operations within one year of joining
