Dr Bhavani
Chennai
Summary
Results-driven claims leader with 18 years of experience in Health, Accident, and Employee Benefits Claims Management across General insurance companies and TPAs. Proven expertise in medical management, fraud control, regulatory compliance (IRDAI), audit handling, and process optimization. Strong leadership capabilities with a track record of improving quality, turnaround time (TAT), and customer satisfaction while ensuring strict adherence to policy terms and regulatory standards.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Lead – Accident, Health & EB Claims
Royal Sundaram General Insurance Company Limited
Chennai
08.2021 - Current
- Lead end-to-end medical management of Cashless, Reimbursement, Hospital Cash, Personal Accident claims
- Ensure accurate claims adjudication in line with policy terms, underwriting guidelines, and regulatory
- Achieved significant reduction in processing errors by implementing a quality control framework.
- Ensured compliance with IRDAI regulations and internal governance standardas. Conducted internal and external audits effectively.
- Monitored performance metrics such as settlement ratios and TAT for continuous improvement.
- Analyzed claims data to detect trends and potential fraud indicators systematically.
- Supervised and mentored claims teams through training programs and performance reviews.
- Collaborated with IT on process enhancements, automation, and workflow optimization.
- Acted as primary liaison with TPAs, hospital networks, and internal stakeholders (Underwriting, Legal, IT, Customer Service)
- Prepare and present MIS reports, risk assessments, and improvement proposals to senior leadership.
Manager – Accident & Health Claims
HDFC ERGO General Insurance Company Limited
Chennai
09.2015 - 07.2021
- Managed accident and health claims operations with focus on quality, compliance, and cost control.
- Supervised claims adjudication, vendor coordination, and customer grievance resolution.
- Supported fraud identification initiatives and audit requirements.
Senior Executive – Health Claims
Royal Sundaram Alliance Insurance Company Limited
Chennai
12.2010 - 09.2015
- Handled cashless and reimbursement claims across multiple health insurance products.
- Reviewed medical records, policy coverage, and billing documents.
- Coordinated with hospitals and TPAs for timely claim settlements.
Medical Officer
Good Health Plan Ltd (TPA)
05.2010 - 12.2010
- Conducted medical evaluations and supported claims adjudication processes.
Medical Officer
MediAssist TPA Pvt. Ltd.
12.2007 - 05.2010
- Reviewed clinical documents and provided medical opinions for health insurance claims.
Education
Bachelor of Dental Surgery (BDS) -
Tamilnadu Govt Dental College And Hospital
Chennai, India01.2003
Skills
- Medical Management of Accident and health claims
- Employee benefits administration
- Regulatory reporting and IRDAI compliance
- Fraud detection and Risk mitigation strategies
- Quality control processes
- Audit management practices
- Process improvement initiatives
- Automation solutions
- Team leadership skills
- Performance management strategies
- Stakeholder engagement and management
- Management information systems (MIS) and Data Analysis and Reporting to Leadership team
- Data analysis and reporting
- Claim processing systems expertise
- Microsoft Office proficiency
Certification
Associate of Insurance Institute of India (AIII)
Timeline
Lead – Accident, Health & EB Claims
Royal Sundaram General Insurance Company Limited
08.2021 - Current
Manager – Accident & Health Claims
HDFC ERGO General Insurance Company Limited
09.2015 - 07.2021
Senior Executive – Health Claims
Royal Sundaram Alliance Insurance Company Limited
12.2010 - 09.2015
Medical Officer
Good Health Plan Ltd (TPA)
05.2010 - 12.2010
Medical Officer
MediAssist TPA Pvt. Ltd.
12.2007 - 05.2010
Bachelor of Dental Surgery (BDS) -
Tamilnadu Govt Dental College And Hospital