Dr Devi

Dynamic Medical Claims and Health Insurance Operations Leader with 9+ years of progressive experience across claims adjudication, medical review, fraud detection, provider management, quality assurance, and team leadership. BDS graduate with strong expertise in large-scale cashless claims operations, complex clinical review, policy interpretation, regulatory compliance, and operational performance management. Proven track record in leading high-volume workflows, developing teams, resolving escalations, strengthening claim controls, and delivering measurable cost-containment outcomes.

Chief Manager – Team Leader at Star Health & Allied Insurance Company Limited (2022-01 – Present)

• Lead Pan-India cashless claims processing operations with strategic open-limit thresholds, optimizing workflow efficiency and decision turnaround.
• Spearhead end-to-end pre-authorization and financial enhancement evaluations; serve as a final escalation authority for complex clinical queries and high-tier disputes.
• Drive investigative methodologies to identify and prevent fraudulent or inappropriate claim activity through clinical audits and internal compliance controls.
• Negotiate package structures and Schedule of Charges (SOC) with network hospitals while resolving executive-level provider disputes.
• Monitor team productivity, quality, and turnaround time (TAT) while maintaining adherence to applicable regulatory and policy requirements.
• Implement claim-control strategies that reduce medical inflation leakage and support disciplined claims cost management.

Senior Manager at Star Health & Allied Insurance Company Limited (2020-01 – 2022-12)

• Processed and audited complex medical claims, validating medical necessity against clinical guidelines and active policy criteria.
• Managed policy deductibles, copayments, coinsurance, and reimbursement eligibility assessments with high accuracy.
• Performed deep-dive clinical investigations that identified billing anomalies and contributed to approximately Rs. 5 Crores in documented organizational savings.
• Supervised, trained, and upskilled a team of 50 medical claims processors, improving throughput by approximately 20% while maintaining a 95% baseline accuracy rate.

Manager at Star Health & Allied Insurance Company Limited (2019-01 – 2020-12)

• Managed day-to-day medical review workflows, ensuring adherence to quality benchmarks, clinical guidelines, and policy terms.
• Resolved escalated claims issues using medical expertise and policy interpretation while balancing customer experience with financial responsibility.

Deputy Manager at Star Health & Allied Insurance Company Limited (2017-01 – 2019-12)

• Executed high-volume medical claims reviews with continuous focus on processing speed, policy compliance, medical assessment quality, and accurate decision-making.

Tutor at Adhiparasakthi Dental College & Hospital (2016-01 – 2016-12)

• Provided clinical and academic training to undergraduate dental students across Orthodontics, Periodontics, and Public Health Dentistry.
• Performed and supervised restorative workflows, root canal treatments, extractions, and patient pain-management counselling.

Dentist at Private Dental Clinic (2014-01 – 2015-12)

• Provided general dental care, including extractions, restorative procedures, preventive care, and patient counselling.

Bachelor of Dental Surgery in BDS – The Tamil Nadu Dr. M.G.R. Medical University (2013-01)