Dr. Shambhavi Kothare

• Projects:

➢Involvement with IT for development- Automation and Digitization.

➢Automated manual activities
➢New initiatives to enhance process excellence and ensure risk mitigation like Videography process

➢Worked on system enhancement

➢POC done to verify effectiveness of new tools and AI.

➢Managed projects efficiently, ensuring timely delivery.

• Empanelments:

➢Onboarding direct KLI centers (approximately 200) and Vendors /service providers (having 2000+centers) ensuring PAN India coverage to facilitate business sourcing.

➢Expanding network out of India for business sourcing in more than 5 countries

➢Conducting quality checks to ensure quality enhancement.

➢Analyzed data to identify areas of improvement, implementing changes that resulted in greater operational efficiency.

➢Negotiated price and service with centers and vendors to decrease expenses and increase profit.

• Operations:

➢Streamlined communication channels between departments, facilitating better collaboration on projects across the organization..
➢Co-ordination with internal team for end to end closure of cases.
➢Involving the Accounts, MIS & operations team for faster payments.

➢Maintained compliance with industry regulations by implementing risk mitigation measures and maintaining accurate documentation.

• Network enhancement
  Monitor & drive internal targets
  Ensure quality check of documents & system updation
  Monitor, analyze & report outstanding
• Process & Automation
  Define process of Empanelment & Depanelment
  Involvement with IT for development
  Tariff study before empanelment
• Audit & Case Investigation
  Implement standardized process
  Assign & Monitoring the activity
• Network operations
  Co-ordination with internal team
  Involving the finance, MIS & operations team for faster payments
  

• Networking:
  ➢ Empanelment of hospitals, nursing home, Polyclinic& Diagnostic center for clients with negotiated rates ensuring cost savings.
  ➢ Negotiation on Hospital bills with concerned administrator and treating Doctors to minimize the financial impact on the company.
  ➢ Surprise visits to hospitals and nursing home to ensure process adherence.
  
• Claims Investigation:
  ➢Handled a team of 30 field visit doctors for cashless as well as reimbursement claims scrutiny.
  ➢Claims Analysis
  
• Claims Processing:
  ➢Processed cashless claims
  
• Wellness Programme:
  ➢Organize Health talks & awareness programmers on current medical Topics for Corporate employees & insurance companies.
  ➢Organize Medical services like Health checkup for all age group.

• Provider Empanelment: Empanelment of hospitals, polyclinic & diagnostic centres for our beneficiaries. Revising rate schedule of providers & finalizing
  cost effective rates.

• Case Management: Rate Negotiations with the service providers for cashless cases
  
• Customer Relation Management: Attending corporate meeting to resolve their grievances.
  
• Wellness Programme: Arranging Health talks, Health Camps & other Health initiatives for corporate and insurance companies.