Vigneshwar Mohan

Detail-oriented Medical Claims Analyst with over 9 years of experience in health insurance claims operations. Proven expertise in managing end-to-end reimbursement processes and negotiating settlements to minimize financial risks. Demonstrated success in streamlining claims procedures, significantly reducing turnaround times.

Skilled in medico-legal troubleshooting and representing companies in public forums, ready to leverage these strengths in contributing to a fast-paced insurance environment.

Medical Claims Analyst at Bayzat (Arya Insurance Brokerage) (2023-01 – Present)

Independently oversee end-to-end reimbursement and pre-approval cases in a digital environment.

• Independently oversee end-to-end reimbursement and pre-approval cases in a digital environment.
• Deliver expert medical opinions to contest rejected claims utilizing remote collaboration tools.
• Cultivate and maintain strategic partnerships with insurer medical teams across various regions.
• Optimized digital review and follow-up processes, significantly reducing claims turnaround time (TAT).

Chief Manager - Claims at Star Health Insurance (2017-02 – 2022-12)

Orchestrated health insurance claims operations for six years.

• Orchestrated health insurance claims operations (cashless & reimbursement) for six years.
• Reviewed medical histories and formulated case summaries for claims adjudication.
• Represented the company in ombudsman hearings, medico-legal cases, and public forums.
• Collaborated with solicitors and legal staff on high-value and malpractice claims.
• Enhanced claims procedures, leading to elevated quality assurance standards.
• Negotiated settlements, disputed fraudulent claims, and mitigated financial risks.

Bachelor of Dental Surgery in Dental Surgery – Priyadarshini Dental College and Hospital

Higher Secondary Education – Velammal Matriculation Higher Secondary School

SSLC – Velammal Matriculation Higher Secondary School