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, India10.2014
Skills
Team Management
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
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