Vignesh Vicky

Highly professional Doctor with organized medical officer exposure of 2.9 years and 5 years of dental clinic experience. Proven ability to handle complex medical insurance processes efficiently & effectively. Possesses excellent organizational skills, attention to detail, and thorough understanding of insurance policies & claim procedures.

Medical Officer – Oman pre approval team - NLGIC / LIVA - Chennai

(2025-09)

• Reviewed and adjudicated health insurance claims based on policy terms and medical necessity.
• Analyzed medical records, treatment plans, and hospital bills for claim decisions.
• Evaluated policy coverage, exclusions, and benefit eligibility.
• Ensured compliance with company guidelines and quality standards.
• Maintained accuracy in claim assessment while optimizing claim settlement times

Deputy Manager – Claims - Star Health Insurance - Chennai

(2023-06 - 2025-09)

• Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.
• Assess risk exposure of members in line with medical underwriting policies.
• Manage queries from providers, insurance companies and insured members relating to pre-approval decisions, evaluation and administration.
• Provide medical guidance to the claims Department staff and assistance in ICD coding and CPT procedure coding.
• Deliver excellent customer service to insurance Companies and insured members with a view of achieving maximum client satisfaction.
• Client Management to investigate on claims in order to minimize fraud and abuse.
• Compile data and prepare daily statistical reports to monitor departmental performance and medical trends.
• Checking bill and settling enhancement
• Adjudicating, reviewing & setting on line policy Bazaar Claims & also taking care of all India Banca claims (PNB & SGHIC/ CUB/ BANK OF BARODA/ KERALA GRAHMIN BANK/ GROUP BANK/ STAR BENEFIT POLICIES)

BDS - Dentistry - Sree Balaji Dental College (2015-01 - 2020-08)