Dr. Kamal Kapur — Co-Founder

With 15 years of dynamic experience in the health insurance sector, I specialize in claims processing, fraud detection and prevention, loss minimization, network management, and the implementation of social health insurance programs. I have managed government health insurance schemes across diverse states in India, including Haryana, Uttar Pradesh, Uttarakhand, West Bengal, Mizoram, Jammu & Kashmir, Ladakh, and Gujarat. This has, enabled me to adapt strategies to local contexts effectively. In claims processing, I managed the end-to-end management of insurance claims, ensuring accuracy and timeliness. My role involved scrutinizing complex cases, coordinating with healthcare providers, and using data analytics to prevent and address discrepancies, ultimately reducing claim-related disputes and enhancing client satisfaction. Fraud detection and prevention are crucial aspects of my role. I have implemented robust frameworks to safeguard insurance schemes, leveraging data analytics and industry best practices to identify and mitigate fraudulent activities. Loss minimization is another key focus of my work. I was responsible for developing and executing strategies to reduce financial losses from insurance claims and operational inefficiencies, including negotiating rates and optimizing processes. My efforts in this area are aimed at achieving cost-effective solutions while maintaining high standards of service. Network management involves building and maintaining strong relationships with healthcare providers, negotiating rates, and ensuring that network services meet quality standards. I am dedicated to fostering collaborative partnerships that align with the goals of providing high-quality care to beneficiaries. I am excited to connect with professionals and explore new opportunities aligned with my expertise. Feel free to reach out to discuss potential collaborations or learn more about my work. #HealthInsuranceExpert #MassHealthInsurance #ClaimsProcessing #SocialHealthInsurance #GovernmentInsurance

Stackforce AI infers this person is a Healthcare Management Expert with extensive experience in health insurance and claims processing.

Location: Lucknow, Uttar Pradesh, India

Experience: 20 yrs

Skills

Health Insurance Program Implementation
Network Management
Claims Processing And Management
Fraud Detection And Prevention

Career Highlights

15 years of experience in health insurance sector
Expert in claims processing and fraud prevention
Led government health insurance schemes across multiple states

Work Experience

Medifinder

Founder and Director (1 yr 4 mos)

Bajaj Allianz General Insurance

Vertical Lead-Mass Health Insurance Claims (7 yrs 8 mos)

ICICI Lombard

Regional Manager Provider Management team (1 yr)

ICICI Lombard General Insurance Company Limited

Manager_Claim and Provider Management team (6 yrs 4 mos)

SARASWATI DENTAL COLLEGE & HOSPITAL

Lecturer (3 yrs 7 mos)

Education

Licentiate degree at Indian Insurance Institute

A master's degree at IIHMR, Delhi

Bachelor of dental surgery at SARASWATI DENTAL COLLEGE & HOSPITAL

Dr. Kamal Kapur

Co-Founder

Lucknow, Uttar Pradesh, India20 yrs experience

Highly Stable

Key Highlights

15 years of experience in health insurance sector
Expert in claims processing and fraud prevention
Led government health insurance schemes across multiple states

Stackforce AI infers this person is a Healthcare Management Expert with extensive experience in health insurance and claims processing.

Contact

doctorkamalkapoor@gmail.com LinkedIn

Skills

Core Skills

Health Insurance Program ImplementationNetwork ManagementClaims Processing And ManagementFraud Detection And Prevention

Other Skills

Loss Minimization and Risk ManagementNegotiation and Contract ManagementAnalytical SkillsClaims HandlingFraud DetectionInsurance Fraud PreventionNegotiationDental CareDental SurgeryHealth insuranceClaim InvestigationInsurance ClaimsCustomer ServiceClinical ResearchUnderwriting

About

Experience

Medifinder

Founder and Director

Nov 2024 – Present · 1 yr 4 mos · Lucknow, Uttar Pradesh, India · On-site

As the Founder and Director of Medifinder, I am dedicated to revolutionizing the way patients connect with healthcare facilities. Medifinder is an innovative app designed to empower users by showcasing hospitals' facilities and infrastructure, enabling them to make informed decisions based on their medical needs, distance, budget, and insurance plans.
Currently in the development stage, our mission is to onboard a diverse range of hospitals to create a comprehensive platform that enhances patient access to quality healthcare. I am actively engaging with healthcare providers to highlight their unique offerings and facilitate seamless connections with potential patients.
In addition to hospital onboarding, I am also focused on raising investment to propel Medifinder's growth and expansion. My goal is to enhance the user experience and ensure that patients have the tools they need to find the best healthcare solutions tailored to their individual circumstances.
Key Responsibilities:
Leading the development and strategic direction of Medifinder.
Building partnerships with hospitals and healthcare providers to enhance our platform’s offerings.
Driving investment initiatives to secure funding for app development and marketing.
Collaborating with a talented team to refine user experience and app functionality.
Advocating for patient empowerment and access to quality healthcare.
I am passionate about leveraging technology to bridge the gap between patients and healthcare providers, and I am excited to connect with like-minded professionals and investors who share this vision.

Claims Processing and ManagementFraud Detection and PreventionLoss Minimization and Risk ManagementNetwork ManagementHealth Insurance Program ImplementationNegotiation and Contract Management

Bajaj allianz general insurance

Vertical Lead-Mass Health Insurance Claims

Mar 2017 – Nov 2024 · 7 yrs 8 mos · Ahmedabad, Gujarat, India · On-site

Managed biggest government sponsored health insurance scheme i.e PMJAY_MA Yojna ( portfolio of Rs 3000 crore+ and network of 1500 hospitals.)
Spearheaded the management of government-sponsored health schemes (PMJAY) across five states, leading a team of 73 professionals and 33 medicos to deliver services nationwide to process more than 1000 claims per day and 1500 preauths per day.
Reduced financial losses by implementing robust fraud control frameworks and conducting real-time audits, ensuring compliance and scheme integrity.
Empaneled public and private hospitals, expanding the cashless treatment network for beneficiaries and improving access to quality healthcare.
Influenced underwriting strategies by providing key inputs, which secured competitive rates for new government schemes.

Analytical SkillsClaims HandlingFraud DetectionInsurance Fraud PreventionNegotiationClaims Processing and Management+1

Icici lombard

Regional Manager Provider Management team

Mar 2016 – Mar 2017 · 1 yr · Lucknow, Uttar Pradesh, India · Hybrid

Achieved seamless implementation of government health schemes by engaging with key stakeholders at the panchayat, block, and district levels.
Reduced operational inefficiencies by creating and implementing training materials for hospitals, government workers (ASHA/ANM), and colleagues.
Supervised on-the-ground scheme implementation, auditing healthcare providers and generating real-time feedback that informed higher management decisions.

NegotiationNetwork managementNetwork Management

Icici lombard general insurance company limited

Manager_Claim and Provider Management team

Nov 2009 – Mar 2016 · 6 yrs 4 mos · Lucknow, Uttar Pradesh, India · On-site

Collaborated with government officials to provide technical insights, shaping the development and implementation of claim and enrollment software for government health schemes.
Ensured comprehensive coverage for beneficiaries by actively working with government agencies to define and expand the range of surgical and non-surgical medical procedures available under the RSBY scheme.
Drove smooth scheme implementation by consistently engaging with government and non-government stakeholders at the panchayat, block, and district levels.
Developed and executed training programs for stakeholders, including hospitals, government health workers (ASHA/ANM), and colleagues, to ensure effective scheme rollout.
Managed ground-level implementation through regular audits of healthcare providers and collected real-time beneficiary feedback, which was used to ensure compliance and improve service quality.
Published key MIS reports and dashboards for higher management and government officials, providing essential data for project monitoring and strategic decision-making.

Insurance Fraud PreventionNegotiationClaims Processing and Management