Snehitha Varigonda

Medical Quality Analyst with 3+ years of experience in health insurance operations, medical claims audit, pre-authorization, and claims review. Experienced in PM-JAY and CMHIS claims, Live QC, MAC QC, AAE QC, investigation trigger review, fraud identification, and medical documentation verification. Skilled in assessing medical records, treatment details, claim accuracy, package utilization, and supporting documents while ensuring compliance with applicable guidelines, SOPs, and quality standards.

Strong analytical and documentation skills with a focus on claim accuracy, risk identification, and quality improvement.

Medical Quality Analyst at IndusInd Insurance (formerly Reliance General Insurance) (2026-04 – Present)

• Performed Quality Check (QC) of PM-JAY (Pradhan Mantri Jan Arogya Yojana) & CMHIS (Chief Minister's Health Insurance Scheme) live medical claims for the Meghalaya & Nagaland region.
• Conducted audits of processed health insurance claims to ensure compliance with PM-JAY & CMHIS guidelines, internal SOPs, and quality standards.
• Reviewed investigation trigger cases to identify discrepancies and cases requiring detailed verification.
• Performed QC of MAC rejection cases to validate medical and policy-based rejection decisions.
• Conducted QC of AAE (Auto Approval Engine) cases to ensure accurate auto-approved claim processing.
• Reviewed substandard claims for adherence to PM-JAY & CMHIS claim processing guidelines.
• Identified and analyzed suspected fraud claims, including document verification and escalation of suspicious cases for further investigation.
• Verified medical records, treatment documents, package utilization, and claim accuracy before quality approval.
• Prepared quality feedback and supported continuous process improvement initiatives.
• Maintained high accuracy, productivity, and SLA compliance.

Medical Quality Analyst at Vidal Health Insurance TPA Pvt. Ltd. (2025-06 – 2026-03)

• Conduct medical assessments and process cashless claims.
• Evaluate pre-authorization requests and treatment plans.
• Scrutinize medical records and bills for accuracy and compliance.
• Coordinate with hospitals, doctors, and insurance teams.
• Assess pre-existing diseases, exclusions, and policy coverage.
• Handle queries, escalations, and appeals with medical justification.
• Ensure adherence to IRDAI regulations and internal SOPs.
• Maintain accurate medical documentation and claim records.

Dental Professional at Sri Hari Dental Care (2024-01 – 2025-05)

• Maintained accurate patient charts and ensured adherence to ethical standards.
• Followed sterilization and patient consent protocols.
• Diagnosed and treated oral diseases and injuries.
• Developed and interpreted dental radiographs (x-rays).
• Conducted oral cancer screenings.

– CKS Teja Institute of Dental Sciences and Research (2023-12)