Dr.Rakhi Gyanchandani

Health Risk Management and Health Underwriting

• Conducted comprehensive risk analyses, ensuring accurate pricing for various types of insurance policies.
• Utilized knowledge of insurance principles, policies and procedures to make decisions on risk assessment.
• Defined Underwriting Policy and Product specific risk acceptance tools and thresholds
• Developed and implemented underwriting procedures, establishing useful and accurate processing of applications.
• Maximized underwriting efficiency with the implementation of automated systems for policy evaluations.
• Collaborated with underwriters to optimize policy pricing and risk assessments, improving overall profitability.
• Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
• Maintained compliance with industry regulations and standards by staying current on relevant laws, policies, and best practices.
• Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
• Provided strategic direction for the development of digital platforms aimed at improving customer experience throughout the policy lifecycle.
• Supported long-term business planning by providing key insights from claim data analysis to inform strategic decision-making processes within the organization.
• Collaborated cross-functionally with claims adjusters, actuaries, and legal teams to develop comprehensive risk management solutions.
• Analyzed complex data sets to identify emerging risks, subsequently providing proactive solutions for mitigating potential losses.
• Conducted thorough risk analysis to develop comprehensive insurance strategies for clients.
• Modified, updated and processed existing policies.
• Sharpened professional expertise through continuous learning opportunities such as attending workshops, conferences, and pursuing industry certifications.
• Consistently met or exceeded performance targets by effectively managing daily workload and adhering to strict deadlines.
• Successfully managed a diverse portfolio of clients across multiple industries while maintaining excellent loss ratios over time.

Health Claims

• Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
• Conducted in-depth analysis of claims data, revealing trends that informed future audits and risk assessments.
• Reduced claim losses by applying expert knowledge in identifying potential risks and setting appropriate premiums.
• Maintain ACS and ensure closure of claims within TAT with quality service and fair claim settlement
• Developed a strong knowledge of various insurance products to provide comprehensive guidance during the claims process for diverse clientele.

Health Insurance Products

• Identified potential areas of improvement within existing policies, recommending adjustments that resulted in increased coverage and cost savings for clients.
• Developed comprehensive product portfolios that catered to diverse customer segments and their unique insurance needs.
• Analyzed market trends and competitor offerings, enabling the company to stay ahead of industry developments.
• Optimized sales strategies by training agents on product features, benefits, and target markets.
• Maintained compliance with regulatory requirements by staying updated on industry changes and adjusting product offerings accordingly.

Internal Audits

• Reduced financial risks by identifying discrepancies and ensuring proper documentation within the auditing process.
• Maintained up-to-date knowledge on industry standards, ensuring alignment with regulatory requirements during audits.
• Identified opportunities for premium recovery through diligent review of policyholder records during audits.
• Effectively communicated findings to stakeholders, leading to informed decision-making and strategic planning.
• Proactively addressed potential issues during audits by providing guidance on corrective actions to mitigate risks.
• Handled complaints and grievances using negotiating and problem-solving skills.
• Implemented process improvements that led to more accurate and timely completion of audits.

Health and Wellness

• Reduced healthcare costs for the organization by promoting preventive health measures and early intervention strategies.
• Developed and implemented comprehensive fitness and wellness programs to promote healthy lifestyles.
• Assessed employee needs and preferences through regular surveys, adapting program offerings to better align with workforce interests.
• Promoted mental well-being among staff through mindfulness training sessions, stress management resources, and counseling services referrals.
• Ensured compliance with applicable laws and regulations regarding employee health promotion activities by staying abreast of industry best practices and legal requirements.
• Measured the success of implemented wellness programs through data analysis and reporting, allowing for continuous improvement efforts.
• Enhanced overall wellness by developing and implementing comprehensive health programs for employees.
• Passionate about learning and committed to continual improvement.
• Provided professional services and support in a dynamic work environment.

• Reduced claim processing time by implementing efficient workflow processes and organization strategies.
• Improved department efficiency through the development of standardized templates for common claim forms, significantly reducing errors and redundancies during submission process.
• Accurately coded medical diagnoses and procedures using standardized coding systems, ensuring proper reimbursement for healthcare providers.
• Implemented quality control measures that resulted in increased accuracy rates for submitted health insurance claims across the entire team''s portfolio.
• Collect and make available accurate, up-to-date management data on claims trends to inform underwriting, product development, pricing and claims decisions
• Co-ordinate with all leading TPA's and other related agencies for timely processing of claims and maintain strict vigilance of TPA's processing TAT's, timely deficiency e.g
• Peer review, and contribute to Internal Audits
• Coordinating with the investigators, treating physicians, insureds etc to verify facts
• Handled Ombudsman Claims & sustained company's decisions
• Maintain profile Analysis & MIS & Keep claim reserves updated regularly
• Handled A & H Claims for Western Region Conducted Induction training on Commercial claims for new joiners
• Successfully attended 3 ISO Audits for Royal Sundaram with total conformance

• Claims Investigations: - Managed PAN India Investigations of Health, PA & Death Claims for leading 25 Insurance companies through the team at HO & Branches
• Value Added Services - Preparing Health Check-up packages for corporate/ Insurance Company and co-ordination with preferred providers PAN India for smooth operations
• Provider Network development: Managing the team at HO, holding responsibility for provider network development PAN India. Handled tie-ups with tertiary care & secondary care hospitals
• Responsible for Customer service which includes tracking and analysis of complaints, queries posed through various platforms
• Monitoring, tracking and analysis of IRDA complaints and legal claims.

• Developed innovative treatment strategies to address complex medical cases, resulting in significant health improvements for patients.
• Instructed and advised patients regarding preventive health care measures to promote early detection, diagnosis and management of medical conditions.
• Improved patient outcomes by implementing evidence-based treatment plans and closely monitoring progress.

• Adapted quickly to changing project priorities and job specifications with analytical thinking and task prioritization skills.
• Cured several patients of chronic illness through homoeopathic treatment.
• Ensured quick and speedy relief in acute and emergency conditions

• Worked flexible hours across night, weekend, and holiday shifts.
• Managed time efficiently in order to complete all tasks within deadlines.
• Learned and adapted quickly to new technology and software applications.
• Worked effectively in fast-paced environments.