ABHILASHA GUHA

• Collaborate with senior management and decision makers to identify business scope and assist in sustainable policy designing.
• Policy designing using analytical approach for Insurance Underwriting and Placement.
• Placement related activities RFQ preparation, ventilation to IC & procurement of quotations
• Strategic analysis of the different Insurance Scheme structures to suggest modifications in the process interactions
• Collaborate with Team members in the organization to ensure successful implementation of Insurance scheme and suggesting solutions to the challenges faced.
• Performed statistical analyses to gather data for operational and forecast insurance needs.
• Tender document Preparation, compliance & submission.
• Claims Adjudication & Operations Management with hands on experience in process audit of different International Schemes in countries like Bangladesh, Sri Lanka & Kenya for eminent clients like WWF, NHIF- Kenya.

Operations Management:

• Monitoring the operations related to Cashless & Reimbursement Claim processing.
• Facilitating Claims Audit based on random sampling and data scrutiny.
• Ensuring proper servicing of RSBY Project in Gujarat& Mizoram through maintenance of efficient TAT in delivery of TPA services.
• Ensuring compliance of Statutory Guidelines as defined by MoLE through robust monitoring of data & subsequent audit planning at hospital & beneficiary level.
• Automation of RSBY Claim Query & Rejection Follow-ups for strict compliance of procurement TAT.

Hospital Networking:

• Ensuring Networking with Quality Hospital Providers at negotiated rates.
• Analyzing legal aspect of MOU with addition & deletion of applicable Articles, Clauses & Sub- Clauses.

Analytics & Trigger Identification:

• Ensuring development of in-house software in compliance to the amendments in policy guidelines.
• Determination & formulation of Triggers in in-house operating software.