Sushant Dange

BHMS healthcare professional with 7+ years of experience across hospital clinical operations, ICU and emergency care, health insurance provider management, medical auditing, claims review, fraud control, hospital empanelment, rate negotiation, medical underwriting and TPA coordination. Currently working with ICICI Lombard in H&A Provider Management, with hands-on experience in provider relationships, medical audit, risk analysis, documentation review, claims-related processes and healthcare operations. Earlier hospital experience includes ICU, trauma, emergency, cardiac, paediatric, orthopaedic, gynaecological and medicine cases.

Customer Service Manager – H&A Provider Management, Field Team - ICICI LOMBARD

(2024-03)

• Manage healthcare provider relationships and support end-to-end hospital empanelment and collaboration activities.
• Perform medical auditing, claims-related review, fraud-control checks and risk-factor analysis.
• Coordinate with hospitals/providers for rate-list finalization and negotiation with internal stakeholders.
• Resolve provider and patient queries through cross-functional coordination and structured communication.
• Review quality of care and provider documentation and support documentation-compliance requirements.
• Support revenue-cycle management, appropriate revenue capture, health-plan denials and related process improvement.
• Provide ground support to clients and healthcare providers and maintain operational/data records.
• Handle moratorium and full medical underwriting activities, including risk-factor assessment and PED-related considerations.
• Support strategic planning and implementation in general insurance and healthcare insurance operations.

RMO / ICU Intensivist – Trauma Care Unit - J J PLUS HOSPITAL PVT. LTD., AURANGABAD - Aurangabad

(2022-03 - 2024-03)

• Managed trauma and emergency cases across cardiac, RTA, orthopaedic, gynaecological, paediatric, medicine and oncology presentations.
• Handled diagnosis, treatment, investigations and emergency stabilization in coordination with hospital teams.
• Prepared emergency OT and cath-lab support for cardiac cases and urgent interventions.
• Coordinated with TPAs for case packages, approvals and claim-related requirements.
• Performed/assisted with intubation, central line and ICD-related procedures as required.
• Supported claim verification, fraud-claim review and patient/family counselling.

RMO / ICU Intensivist - VIVEKANAND MULTISPECIALTY HOSPITAL, BHOSARI, PUNE - Bhosari, Pune

(2020-02 - 2022-02)

• Handled ICU and emergency cases involving cardiac, orthopaedic, medicine and gynaecological conditions.
• Managed acute presentations including myocardial infarction, respiratory failure, poisoning and emergency obstetric cases.
• Coordinated with TPAs for packages involving ventilator support and emergency surgical procedures.
• Supported emergency diagnosis, stabilization, treatment and multidisciplinary coordination.

Registered Medical Officer (RMO) – Paediatric ICU - MANIK MULTISPECIALITY HOSPITAL, AURANGABAD - Aurangabad

(2019-01 - 2020-01)

• Worked in Paediatric ICU with responsibility for emergency management, daily rounds, diagnosis and treatment.
• Performed/assisted with critical-care procedures including intubation and central-line related procedures.
• Handled claims-related queries and updated claims profiles with diagnostic and procedure information.
• Coordinated clinical information required for claims and hospital operations.

B.H.M.S. - Homoeopathic Medicine - Shri Bhagwan Homoeopathic Medical College, N-6 CIDCO, Aurangabad

MS-CIT - Information Technology - Maharashtra State Board of Technical Education, Mumbai

Licentiate-level insurance studies - Insurance - Insurance Institute of India (III), Mumbai