Anu Grover
Haryana
Summary
Dynamic claims management professional with extensive experience in health insurance, excelling in claims analysis and team leadership. Proven track record in fraud control and negotiation, enhancing client satisfaction and operational efficiency. Adept at developing strategic insurance plans that address complex client needs, ensuring accurate claims processing and resolution.
Overview
11
11
years of professional experience
Work History
AVP Health Claims
XtraTrust Insurance Brokers Private Limited
Gurgaon
04.2025 - Current
- Develop strategic insurance plans that effectively address complex client needs, leading to increased satisfaction.
- Managing a portfolio of key client relationships, serving as a primary point of contact for all service inquiries.
- Analyzing detailed health claims to ensure accuracy, as per policy terms.
- Serves as a liaison between clients and TPA providers to resolve processing disputes and claims discrepancies.
- Verify insurance coverage for all claims by meticulously reviewing medical records, ensuring proper claims submission, and payment.
General Manager Claims
VOLO HEALTH INSURANCE TPA PRIVATE LIMITED
New Delhi
02.2023 - 03.2025
- End-to-end handling of cashless and reimbursement claims.
- Managed team of more than 50 members, including doctors and non-medical staff.
- Take care, TAT, through fair and prompt processing of claims.
- Conducted regular performance reviews to assess individual team member progress.
- Assisted with recruitment efforts by interviewing potential candidates and providing input on hiring decisions.
- Monitored daily workflow to ensure adherence to established policies and procedures.
- Resolved customer complaints in an effective manner while maintaining a high level of customer service.
- Participated in regular meetings with senior leadership to provide updates on team progress.
- Assigned projects and distributed tasks to team members as per area of expertise.
- Investigated suspicious or fraudulent claims and reported findings to management.
- Coordinated with insurer and brokers to ensure efficient resolution to escalated matter and grievance.
Chief Manager Claims
Health Insurance Tpa Of India Limited
Noida
05.2022 - 02.2023
- Multitasking abilities
- Leadership
- Handling escalations related all cashless, reimbursement & GIPSA claims
- Member of CRG committee, taking care of claims above 7.5 Lac
- Handling of cashless processing team (Medical)
- Managing smooth settlement of cashless and reimbursement
- Managing relationship with PSU insurer for disbursement of large amount claims
Claims Manager
Max Bupa Health Insurance Company Limited
New Delhi
12.2018 - 05.2022
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations
- Identified suspicious Claims and contacted Investigation team for investigative assistance
- Followed up with Hospitals on unresolved issues
- Negotiated new and renewal surgery and other packages with various hospitals
- Interacted with Hospital Administration for smooth processing of claims
Claims Head (Cashless)
Med Save Health Insurance TPA Ltd
New Delhi
12.2015 - 12.2018
- Supervised 5 Doctors and non-medical team providing excellent customer service
- Evaluated claims within the regulatory and internal guidelines
- TAT management & analysis
- Resolved grievances against higher billing by hospital
- Negotiated with the TPA desk and treating doctor about medical packages
- Maintained Customer Relationship at beneficiary level, hospital level & corporate
Deputy Manager Claims
Star Health and Allied Insurance Co Ltd
New Delhi
08.2014 - 10.2015
- Worked with General Manager Claims under Cashless Department
- Processed all type of cashless claims
- Scrutiny of document related to cashless claims
- Follow up with Hospital for arranging of query document
- Negotiated agreements between employer and Hospital for surgery package
- Generated cashless report on daily basis
Education
PG Diploma - Hospital And Health Management
Medvarsity University (Apollo)
New Delhi09.2012
Graduation - Bachelor of Dental Surgery
M J C D V Dental College (KU)
Sirsa03.2011
Higher Secondary - Science
Sawan Public School
Sirsa03.2005
High School -
DAV Public School
Sirsa03.2003
Skills
- Planning and organization
- Claims analysis
- Claims investigation and research
- Negotiation and mediation skills
- Loss protection
- Fraud control
- Team handling
Accomplishments
- Cost Containment
- TAT Management
- Good NPS Score
Personal Information
- Father's Name: Mr. C K Grover
- Date of birth: 05/29/87
- Marital status: Married
Timeline
AVP Health Claims
XtraTrust Insurance Brokers Private Limited
04.2025 - Current
General Manager Claims
VOLO HEALTH INSURANCE TPA PRIVATE LIMITED
02.2023 - 03.2025
Chief Manager Claims
Health Insurance Tpa Of India Limited
05.2022 - 02.2023
Claims Manager
Max Bupa Health Insurance Company Limited
12.2018 - 05.2022
Claims Head (Cashless)
Med Save Health Insurance TPA Ltd
12.2015 - 12.2018
Deputy Manager Claims
Star Health and Allied Insurance Co Ltd
08.2014 - 10.2015
PG Diploma - Hospital And Health Management
Medvarsity University (Apollo)
Graduation - Bachelor of Dental Surgery
M J C D V Dental College (KU)
Higher Secondary - Science
Sawan Public School
High School -
DAV Public School
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