Feb 2017 – Apr 2019 · 2 yrs 2 mos

• Manage E2E of Utilization Management, this includes the Inpatient Care Management, Prior authorization, Retrospective review, Medical Claims Review, Bed Day metrics, Notification (Voice, Fax), Pharmacy Appeals, Gaps in Care, HEDIS

Aug 2014 – Jan 2017 · 2 yrs 5 mos

• Utilization Management- Inpatient Care Management, Prior Authorization , Medical Claims Review

May 2012 – Aug 2014 · 2 yrs 3 mos

• Lead teams that have clinical and claims operations responsibilities including reviewing medical records, investigating fraud, waste and abuse, reviewing reimbursement policies, and identifying and recovering overpayments
• Use appropriate control mechanisms to monitor and manage multiple teams and serves as contact point for stakeholders
• Ensure execution and high level of delivery on all projects
• Foster and collaborate with all internal and external customers to ensure customer satisfaction.
• Build and review business scorecards and performance metrics for the assigned teams and appropriately builds action plans.
• Partner with the Senior Leadership in planning, implementation and evaluation / modification of existing operations, systems and procedures.
• Drive teams to maximize performance while maintaining high standards of quality & ensure the organization meets Service Level Agreements / Performance Guarantee goals.
• Oversee, and directly lead, quality and process improvement initiatives
• Establish and maintain an environment conducive of positive morale, creativity and team work and partners in the formulation of career progression / employee development plans
• Hiring, coaching, mentoring and performance management of staff to ensure talent is working toward improving our business and servicing our customers
• Collaborate with Human Capital to develop and implement retention strategies.

Jan 2012 – May 2012 · 4 mos · Chennai Area, India

Feb 2007 – Jan 2012 · 4 yrs 11 mos · Chennai Area, India

• Heading a 550 member team in Life Vertical which has 5 Operations Managers, 6 Client Managers
• Transitioned multiple accounts successfully that got BAU status in record time of 4 months only. Established Quality monitoring, Feedback, Calibration and Alert processes.
• Maintaining Quality Management System and Information Security Management System across Life Vertical
• Instrumental in developing performance dashboards, key metrics & organisation wide Productivity & Capacity Utilization Index
• Continuously evaluate department performance in relation to goals and budget and recommend new approaches, policies and procedures to effect improvements in efficiency and services performed

Jul 2006 – Feb 2007 · 7 mos

• Lead a team of 32 Assistant Underwriters
• Managed all Compliance Operations.
• Established Internal Compliance Review, Risk Assessment & Management Consultation Methodology to all BP & IT Operations. Managed Training & Development Programs on FSA, DPA, Money Laundering Prevention, Financial Crime, Complaints handling and System Security Awareness for all Staff.
• Maintain an audit on all the files which are not jet approvals and jet declines.
• Making and sending of dashboard to the customer.
• Coordinating between the Examine (Lab for the blood work) and the Assistant underwriters.
• Working on all the cases which are for more than $ 350,000.
• Assist in development and implementation of solutions designed to improve department productivity/efficiency/accuracy
• Maintain information and documentation on an on-going basis in order to prepare and present employee performance appraisals
• Handling escalated calls from the customers and also calling the customer where important details are required in relation with the customer medical history.
• Responding to the mails from the branches.
• Took initiative to establish Standard Operating Procedures, Systems and Workflows for all processes.
• Involved in Continuous Improvement Project by identifying problem definition for improving productivity and accuracy levels.

Jan 2005 – Jun 2006 · 1 yr 5 mos

• Appraise medical risks for Life Insurance applications
• Using factors such as occupation, age, medical history, financial standing & other relevant conditions that determine insurability
• Appraise level of risk involved in applications with adverse medical findings, where medical decision or opinion is necessary
• Evaluate medical condition & analyze the test results of the applicants
• Recommend, accept, reject, insurance coverage within limits set in the Underwriting policy
• Support line management on maintenance & updation of data base
• Mentoring & training of new hires

Jan 2004 – Jan 2005 · 1 yr

Jan 2002 – Dec 2004 · 2 yrs 11 mos

• Claims Adjudication
• Hospital Networking & monitoring of cashless hospitalizations
• Standardization of Hospital tariffs

Jul 2000 – May 2002 · 1 yr 10 mos

• Managed critical patients in the Emergency, ICU & Post Operative cases
• Case History preparation