Dr. Simile Subramanian

Head of Operations for Corporate Health Benefits - Senior Manager

Led operational strategy and implementation, ensuring SLA compliance and effective provider management. Improved processes to boost sales and customer satisfaction, achieving a GM growth of over 26%.

Key Teams and Responsibilities:

Provider Management

• Established partnerships with healthcare providers for comprehensive corporate wellness.
• Ensured minimum GM of 20%.
• Conducted vendor reviews to enhance service quality, maintaining CSAT of over 80%.

Launch Operations

• Managed launch of health and check-up plans within set SLAs.
• Achieved launch TAT of over 96%.

Concierge Services

• Maintained SDR% above 65% with SLA breaches below 20%.
• Ensured CSAT of over 80%.
• Achieved 100% OTIF (On Time In Full) for service delivery.

OPD Claim Processing

• Oversaw timely processing and settlement of in-house and insurer-backed OPD claims within prescribed TAT.
• Automated manual processes using technology solutions, increasing accuracy and efficiency within operations

• Established and maintained strong relationships with various healthcare providers to ensure comprehensive wellness solutions for corporate clients.
  
• Monitored partner performance and conducted regular reviews to ensure adherence to service level agreements (SLAs) and quality standards.
  
• Analyzed financial performance and implemented measures to enhance profitability, achieving gross margin (GM) of over 20%.
  
• Collaborated with cross-functional teams to drive efficiency and streamline operations, contributing to overall business growth.
  
• Regularly reviewed and adjusted strategies to adapt to changing market conditions and maintain competitive advantage.

Oversaw medical tourism adjudication, managed revenue cycle, and ensured compliance with regulations

• Directed medical tourism adjudication, ensuring accurate assessment and approval of international patient services.
• Managed entire revenue cycle from registration to billing, ensuring timely financial transactions and compliance with regulations.
• Developed policies to streamline adjudication and collaborated with stakeholders to maintain transparency and efficiency.

Conducted audits to identify cost-saving opportunities and enhance operational efficiency

• Conducted comprehensive audits of processes and transactions to identify inefficiencies and potential cost-saving opportunities.
• Analyzed audit findings to develop actionable recommendations for improving efficiency and reducing expenses.
• Implemented audit-driven changes and collaborated with department heads to ensure successful execution and continuous improvement.

Managed cashless claims and internal audits to ensure quality and efficiency

• Oversaw the entire cashless claims process, ensuring timely and accurate processing in collaboration with healthcare providers and insurers.
• Implemented internal audits to review and improve claims procedures, maintaining high standards of quality and regulatory compliance.
• Analyzed audit results and provided training to the claims team, driving continuous improvement and operational excellence.

Provided medical consultation and support to the pre-authorization team

• Offered expert medical advice to the pre-authorization team, ensuring decisions were aligned with clinical guidelines.
• Worked with healthcare providers to obtain necessary documentation, enhancing the accuracy and reliability of pre-authorization approvals.
• Conducted training and facilitated communication between departments to support efficient and informed pre-authorization processes.

Implemented control tower mechanism to keep the prescribed TAT of 3 hours for the pre-authorization of the claims

• Established and managed a control tower system to monitor the pre-authorization process in real-time, ensuring a 3-hour turnaround time.
• Developed workflows and utilized tracking tools to streamline pre-authorization, promptly addressing any delays or issues.
• Conducted performance reviews and implemented continuous improvement initiatives to maintain efficiency and meet TAT consistently.

Provided medical opinion and support for policyholder inquiries (March 2014 - Aug 2015)

• Conducted audits, reviewed grievance files, and settled reimbursement claims Provided medical opinion and support for policyholder inquiries.

Medical Adjudication and Audit of Cashless Claims (Jun 2012 - Sep 2013)

• Managed the medical adjudication process for cashless claims, ensuring accurate assessments and compliance with established protocols.
• Conducted audits of cashless claims to identify discrepancies, enhance accuracy, and improve operational efficiency.

• Provided comprehensive patient care and assisted in outpatient and inpatient services.