Summary
Overview
Work History
Education
Skills
Languages
Projects
Certification
Timeline
AssistantManager

Dr. M.M.Palaniappan

Health Insurance Leader & Data Analyst| Claims , Pricing & Data Analytics
Hyderabad,TG

Summary

Experienced health insurance professional with nearly a decade of expertise in claims handling, pricing & provider management and fraud control. Recent foundational knowledge in Data Analytics, prompt engineering and hands-on experience in Python and SQL.

Overview

9
9
years of professional experience
2
2
Certifications

Work History

Zonal Cashless Claims Head

Aditya Birla Health Insurance
3 2024 - 8 2024
  • Oversaw cashless claims processing across multiple zones.
  • Resolved problems, improved operations and provided exceptional service.

Deputy Head - Pricing and Provider Management.

Star Health And Allied Insurance
01.2022 - 01.2024
  • Managed pricing strategies for top hospitals across zones.
  • Continuous engagement with the network providers, focusing on ethical practices and growth of the healthcare industry

Deputy Head - Claims Department & Fraud Management

Star Health And Allied Insurance
12.2019 - 01.2022
  • Managed claims portfolio of ₹1000 crores, led a team of 25 people.
  • Handled both cashless and reimbursement claims, Medical Auditing, Fraud management.

Team Leader, Claims Department

Star Health And Allied Insurance
01.2018 - 12.2019

Claims Processor

Star Health And Allied Insurance
05.2015 - 12.2017

Education

Data Analytics

IBM
10.2024

Prompt Engineering

Vanderbilt University
09.2024

Bachelor of Dental Surgery

Chettinad Dental College & Research Institute
Chennai, India
10.2014

Skills

Team Management

Teamwork and Collaboration

Problem-solving

Analytical and Critical Thinking

Programming (Python, SQL, ChatGPT)

Microsoft Office

Calm Under Pressure

Pricing and Negotiation

Auditing Claims

Languages

English
Bilingual or Proficient (C2)
Tamil
Bilingual or Proficient (C2)
Telugu
Elementary (A2)

Projects

  • Project on Miscellaneous Line Items, Identified and analyzed inflated hospital bill items to control costs.
  • Fraud Management in Claims - Developed a data-driven model to identify patterns in claims for fraud detection.

Certification

Data Analyst

Timeline

Data Analyst

10-2024

Prompt Engineer

09-2024

Deputy Head - Pricing and Provider Management.

Star Health And Allied Insurance
01.2022 - 01.2024

Deputy Head - Claims Department & Fraud Management

Star Health And Allied Insurance
12.2019 - 01.2022

Team Leader, Claims Department

Star Health And Allied Insurance
01.2018 - 12.2019

Claims Processor

Star Health And Allied Insurance
05.2015 - 12.2017

Zonal Cashless Claims Head

Aditya Birla Health Insurance
3 2024 - 8 2024

Data Analytics

IBM

Prompt Engineering

Vanderbilt University

Bachelor of Dental Surgery

Chettinad Dental College & Research Institute
Dr. M.M.PalaniappanHealth Insurance Leader & Data Analyst| Claims , Pricing & Data Analytics