Dr Arun Kantaram Gadekar
Pune
Summary
Operations leader with proven track record at Health Insurance TPA of India Ltd, achieving 30% reduction in claims processing time. Specializes in health plan operations and stakeholder management, with strong focus on process improvement and team leadership. Ensures compliance and delivers exceptional customer service in diverse healthcare settings.
Overview
15
15
years of professional experience
Work History
Deputy Manager
Health Insurance TPA of India Ltd
Pune
09.2015 - Current
- Led operations in claims processing and managed a team of over 50 professionals to achieve operational excellence.
- Developed process improvement initiatives, decreasing claims processing time by 30% and enhancing member satisfaction.
- Conducted regular audits to ensure compliance with IRDA regulations.
- Collaborated with cross-functional teams to enhance service delivery and implement new technologies for streamlined workflows.
- Oversaw complete branch operations in Pune and throughout Maharashtra.
- Facilitated regular meetings with insurers and brokers to address business issues and resolve service-related challenges.
- Ensured timely processing of claims and resolution of grievances per SLA requirements.
- Delivered excellent services to over 350,000 customers while negotiating tariffs for medical procedures
- Periodic audit of hospitals and stakeholders.
- Developed and implemented new procedures to improve efficiency of the organization.
- Coordinated with other departments to ensure smooth functioning of activities.
- Provided necessary technical assistance and advice to subordinates when needed.
- Created processes for handling customer complaints effectively.
- Monitored daily operations and ensured compliance with company policies and regulations.
- Provided guidance and support to team members to help them achieve goals.
- Collaborated with vendors and suppliers to secure best deals on products and services purchased by the organization.
- Prepared monthly progress reports detailing achievements against set targets.
- Oversaw budgeting responsibilities, reducing costs and increasing margins.
- Maintained records of all operational activities for future reference.
- Worked closely with customers to understand needs and resolve diverse issues.
- Analyzed claims data to identify trends and adjust strategies accordingly.
- Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
- Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
- Assigned work and monitored performance of project personnel.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Analyzed business performance data and forecasted business results for upper management.
- Planned and led team meetings with the insurer and broker to review business results and communicate new and ongoing priorities.
- Implemented quality control measures to uphold company standards.
Program Officer
Rajeev Gandhi Jeevandayee Arogya Yojana
04.2013 - 09.2015
- Empanelment of hospitals in State of Maharashtra across 36 district
- Periodically Monitoring and Evaluation of performance of hospitals under RGJAY Govt. scheme
- Empaneled more than 800 hospitals under stipulated timeframe
- Trained stakeholders about NABH tools and implement in their respective hospitals
- Audit of Network hospitals and ensure the Quality treatment to end-user
- Analysis of critical data and prepared action plan to delivered quality outputs
- Strengthening of manpower and continuous training to field staff about implementation of new guidelines
- Managed 900+ network hospitals across of Maharashtra state
- Responsible for provider management activities like Hospital empanelment, claim negotiations, and provider and customer relation
Medical Officer
Paramount Health Services (TPA) Pvt Ltd
Mumbai
07.2010 - 05.2011
- Investigation of high value and suspected claims
- Control fraud and abuse claims with thoroughly investigation
- Reduced claim size and process the file as per SLA
- Achieved given target on weekly basis
Education
MHA -
TISS
03-2013
BAMS -
MUHS Nashik
03-2009
HSC -
Pune University
03-2003
SSC -
Pune University
03-2001
Skills
- Health plan operations management
- Compliance oversight
- Process improvement
- Stakeholder engagement
- Data analysis
- Project management
- Team leadership
- Quality assurance
- Customer service excellence
- Financial analysis
Disclaimer
I hereby declare that the information furnished above is true to the best of my knowledge.
Accomplishments
- Star performer in the year of 2018
- Best branch performance in FY 2023-24
Languages
Marathi
First Language
English
Advanced (C1)
C1
Hindi
Advanced (C1)
C1
Timeline
Deputy Manager
Health Insurance TPA of India Ltd
09.2015 - Current
Program Officer
Rajeev Gandhi Jeevandayee Arogya Yojana
04.2013 - 09.2015
Medical Officer
Paramount Health Services (TPA) Pvt Ltd
07.2010 - 05.2011
MHA -
TISS
BAMS -
MUHS Nashik
HSC -
Pune University
SSC -
Pune University
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