Dr. Shweta Todankar Salunke

• Leading client relationships for large corporate accounts in personal accident claims.
• Ensuring timely decisions on all claims within the designated turnaround time.
• Coordinating with investigation, product, networking, and underwriting teams to facilitate claim processing.
• Achieve a high claim settlement ratio exceeding 97%.
• Conducting training and development programs for team members.
• Providing regular data reports to Claims Head and corporate clients.

• Led Personal Accidents and Critical Illness (PACI) team to ensure timely decisions on all claims.
• Oversaw Domestic Travel claims processing.
• Managed litigation cases, including representation in court.
• Coordinated with investigation, product, Networking, and underwriting teams for efficient claim handling.
• Processed reimbursement cases to ensure accurate financial settlements.
• Regularly reported data and updates to Claims Head for informed decision-making.
• Prepared comprehensive case notes with evidence for litigation defence.
• Participated in litigation cases when medical intervention was necessary.

• Managed travel and health insurance claims, ensuring timely processing and accuracy.
• Conducted medical scrutiny of all reimbursement and cashless claims, focusing on benefit and indemnity.
• Handled representation for repudiation cases, advocating for claim resolutions.
• Oversaw TPA management through audits, tracking, and improving settlement ratios.
• Provided medical approvals for TPA-processed and repudiation cases to expedite outcomes.
• Led governance calls with TPA and cross-functional teams to enhance collaboration.
• Trained new recruits on health and travel claim profiles, fostering knowledge transfer.
• Identified fraud patterns and collaborated with investigators on pre-existing disease cases.

Networking Team:

• Emplaned hospitals across India.
• Negotiated rates and packages with hospitals.
• Strengthened hospital relationships, and resolved grievances efficiently.

Loss Control Measures Team:

• Performed risk assessment and implemented mitigation strategies.
• Generated accurate daily reports and comprehensive claims documentation.
• Analyzed hospital settlement data monthly to inform strategic decisions.
• Executed LCM activities to evaluate reasonable and customary charges.
• Facilitated second level negotiations with providers to resolve billing disputes.
• Collaborated with provider contracting team to address errant hospitals.

Claim Processing Team:

• Processed reimbursement claims for all PSU customers in the retail sector.
• Conducted claims handling and investigations to ensure accuracy.

• Managed patient care and administrative functions in hospital setting.
• Handled gynecological, obstetric, oncology, and gastroenterology cases.
• Assisted in lower segment cesarean sections and abdominal hysterectomies.
• Supported modified radical mastectomies and benign breast tumor surgeries.
• Facilitated laparoscopic procedures including appendectomy and cholecystectomy.
• Conducted minor surgeries such as minimal invasive hemorrhoidectomy and tubal ligation.
• Collaborated with surgical teams to enhance patient outcomes.
• Maintained accurate records and ensured compliance with health regulations.

• Reviewed insurance applications for compliance with legal standards and company policies.
• Analyzed medical reports to assess risk factors affecting claim acceptance or denial.
• Presented decisions to senior underwriters for evaluation and further action.
• Assessed client business needs to ensure tailored service delivery.