Dr. Ashwini Ramteke

• Empanelled and managed network of provider for entire south zone.
• Overseen audit and mystery shopping.
• Developed detailed plans based on broad guidance and direction for enhancing the network.
• Established performance goals for employees and provided feedback on methods for reaching those milestones.
• Established team priorities, maintained schedules and monitored performance.
• Leveraged data and analytics to make informed decisions and drive business improvements.
• Set aggressive targets for employees to drive company success and strengthen motivation.
• Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.

• Carried out Quality check for new empanelment of hospital in ABHI network by scrutinizing system requirements.
• Studied and analyzed hospital tariff and rates by difference calculation to achieve cost effectiveness.
• Conferred with Account managers and Zonal managers each day to maintain current understanding of needs and preferences and resolve issues.
• Performed Impact analyses for rate/tariff revision of empaneled hospitals including ACS and year on year claim amount calculation.
• Maintained, documented and presented progress reports and published dashboards in timely manner.
• Issued De-empanelment letters to hospitals.
• Performed root-cause analysis on operation-related problems to recommend or execute corrective action.
• Handled escalations on priority basis and provided quick resolution by effective communication and coordination with internal and cross-functional teams.
• Projects

1. Tariff digitization

• Reviewed, evaluated and identified requirements for project.
• Tested, identified and troubleshot problems with help of vendor communication.

2. Price listing

• Compiled, developed and created exhaustive list of services for tariff standardization.
• Analyzed and evaluated claims data to identify trends, patterns and done price benchmarking.

• Processed in-house claims with quality, ensuring admissibility, claim amount adjudication, adherence to tariff and completed end to end process within TAT
• Done Denial claims calling with customer management and handled escalated cases and grievances.
• Referred claims to FWA team for claim investigation and timely followup.
• Coordinated and work with internal and cross functional teams like Underwriting, New business, Sales for resolution of claims related issues.
• Worked as SPOC for underwriting team to aid in decision related to policy cancellation.
• Performed Case management and Claim cost saving activity.
• Digital transformation - Performed testing in pre-pod environment for claims operation.