BASAVARAJ PATIL
Bangalore
Summary
Healthcare management professional with MBA-PGPEM background and proven results in operational efficiency, claims integrity, and service excellence across multidisciplinary healthcare environments. Expertise in claims governance, review framework optimization, data-driven accuracy validation, compliance alignment, and fraud-risk mitigation. Strong knowledge of medical benefits reimbursement, regulatory guidelines, hospital operations, patient care protocols, and infection control practices to support end-to-end quality standards. Background in audit readiness, confidential data management, documentation accuracy, and continuous monitoring.
Overview
4
4
Languages
1
1
Certification
11
11
years of professional experience
Work History
Assistant Manager- Claims Department
Medi Assist Healthcare Private Limited
Bangalore
01.2025 - 08.2026
- Advised on cashless and reimbursement claims for process accuracy daily.
- Reviewed claims workflows for regulatory compliance and consistent decisions.
- Provided decision support for complex medical cases using SME guidance.
- Monitored staff performance and developed improvement plans.
- Trained new employees on company policies, customer service excellence, and sales techniques.
- Coordinated with senior management to implement strategic plans for revenue growth.
- Resolved escalated customer complaints by offering practical solutions and maintaining professionalism.
- Led weekly staff meetings to discuss targets, performance improvements, and customer feedback.
- Oversaw work of administrative staff supporting [Type] operations and facilitated key cross-functional collaboration.
Assistant Manager- Claims Department
Medi Assist Healthcare Private Limited
Bangalore
01.2017 - 04.2023
- Acting as the Subject Matter Expert (SME) for both cashless and reimbursement claim operations, ensuring process accuracy, regulatory compliance, and seamless decision support for complex medical cases.
- Leading and supervising a 14-15 member claims operations team, driving performance excellence through structured guidance, mentoring, and continuous capability development for new and existing team members.
- Evaluating medical records and treatment protocols, providing expert clinical recommendations to support appropriate decision-making and adherence to medical guidelines.
- Establishing and enforcing quality benchmarks across operational workflows, ensuring high service delivery standards, SLA adherence, and consistent customer experience improvement.
- Executing delegated Quality Assurance mandates, contributing to risk minimization, audit readiness, and strengthening governance across claims management processes.
- Validating provider documentation and benefit applications, ensuring alignment with enrolment criteria, plan design specifications, and applicable regulatory frameworks.
Senior OT Nurse
Shekhar Multispeciality Hospital
Bangalore
09.2015 - 12.2016
- Supported safe and efficient surgical care by preparing patients for operative procedures and supervising the sterilization, readiness, and compliance of OT instruments and equipment.
- Anticipated the requirements of surgeons and multidisciplinary surgical teams and facilitated smooth intraoperative workflows to enhance procedural efficiency and patient outcomes.
- Maintained a state of operational readiness in the Operating Room by upholding strict quality benchmarks, safety precautions, and infectioncontrol protocols.
- Compiled and reported monthly patient-safety metrics, particularly regarding pre-operative antibiotic administration, to strengthen clinical governance and regulatory compliance.
- Contributed to hospital-wide Quality Assurance (QA) initiatives that consistently exceeded institutional standards for patient and staff safety.
- Transitioned from the Main OR to a newly established, state-of-the-art same-day surgical unit, ensuring seamless adaptation of processes and workflows.
- Played a pivotal role in designing and optimizing patient-flow patterns and improving room-turnover efficiency, directly enhancing surgical throughput and operational productivity.
Education
MBA PGPEM - Healthcare Management& Digital Marketing
Bangalore Institute of Management Studies
Bangalore01.2020
B.Sc. - Nursing
Rajiv Gandhi University of Health Sciences
Bangalore01.2015
Skills
- Claims processing and adjudication
- Fraud detection and cost containment
- Medical benefits management
- Provider documentation review
- Quality assurance in healthcare
- Patient care operations
- Surgical procedures and protocols
- Pre-operative and post-operative care
- Clinical documentation and reporting
- Critical care procedures
- Process improvement strategies
- Data accuracy and compliance auditing
- Risk assessment management
- Cross-functional coordination
- Team leadership and training
- Performance monitoring strategies
- Customer escalation handling
- Claims management
- Performance monitoring
- Quality assurance
- Medical documentation
- Customer relationship management
- Team leadership
- Cross-functional collaboration
- Operational support
- Business operations understanding
- Project Management
- Department management
Certification
- Information Security Management System (New Version-2025) by MediAssist, MediAssist, 2025, 2025-01-01
- Policy Creation Process by MediAssist, MediAssist, 2025, 2025-01-01
- Work Ethics by MediAssist, MediAssist, 2025, 2025-01-01
Accomplishments
- Achieved cost savings of INR 90 Lakhs by identifying and eliminating fraudulent claims, strengthening financial governance and organizational integrity.
- Enhanced patient record accuracy by implementing robust documentation checks and improving data-management practices across operational workflows.
- Delivered advanced EHR (Electronic Health Records) training for new and existing staff, elevating system proficiency, reducing errors, and improving data-driven decision-making.
- Recognized with multiple performance awards, including "Best Employee of the Year - 2018 & 2019," for excellence in operations, service delivery, and leadership impact.
Languages
English
Kannada
Hindi
Telugu
Custom Section
- Driving customer-centric initiatives aimed at enhancing consumer satisfaction, operational efficiency, and overall business performance through data-backed process optimization.
- Managing high-priority customer escalations, coordinating corrective actions with cross-functional teams, and ensuring timely closure while maintaining service quality and organizational reputation.
- Managing documentation accuracy and MIS reporting, enabling informed decision-making, operational transparency, and compliance tracking for senior leadership.
- Spearheading EHS-aligned onboarding, training, and team-development programs, strengthening workforce readiness, promoting safe work practices, and building high-performing teams through structured training interventions.
- Contributing to managerial decision-making, supporting resource planning, workflow allocation, performance monitoring, and continuous process improvement initiatives across the Claims Department.
Timeline
Assistant Manager- Claims Department
Medi Assist Healthcare Private Limited
01.2025 - 08.2026
Assistant Manager- Claims Department
Medi Assist Healthcare Private Limited
01.2017 - 04.2023
Senior OT Nurse
Shekhar Multispeciality Hospital
09.2015 - 12.2016
MBA PGPEM - Healthcare Management& Digital Marketing
Bangalore Institute of Management Studies
B.Sc. - Nursing
Rajiv Gandhi University of Health Sciences