Dr. Upasana Priyadarshini
Bengaluru
Summary
Operations manager with extensive experience in team leadership and operational efficiency within healthcare settings. Proven expertise in insurance claims processing and compliance, resulting in timely deliverables and improved workflow.
Overview
10
10
years of professional experience
Work History
Operations Manager
The Cigna Group
Bangalore
01.2025 - Current
- Executed managerial duties to ensure effective training and staff development.
Controlled claims costs using equitable and fair methods.
Coordinated closely with reporting manager on staff performance reviews and scheduling.
Delegated tasks and oversaw activities of claims examiners.
Monitored pipelines and queues daily for optimal performance.
Identified training needs and conducted sessions for team enhancement.
Maintained assigned turnaround times while optimizing resource utilization.
Addressed internal grievances, escalating to reporting manager when necessary.
Assistant Network Manager
Vidal Health Insurance TPA Pvt. Ltd
Bengaluru
05.2023 - 12.2025
- Perform job supervisory duties to assure proper training, instructions, and development of staff.
Control claims cost by all permissible, equitable, fair means.
Closely coordinate with the Reporting Manager-Claims on staff performance reviews and leave scheduling;
Delegate and oversee activities performed by claims examiners.
Daily monitoring of pipelines and queues.
Identify training requirements within the team and perform training sessions.
Responsible in maintaining the assigned TAT of the respective teams and ensuring the optimal utilization of
resources.
Address any internal grievances and escalate to reporting manager if required.
Responsible for reporting of identified Claims Fraud, Waste and Abuse trends and escalating to concerned
parties
Escalate any identified software issues to the reporting manager and IT POC as required.
Identify gaps in performance and offer coaching to officers as needed.
Proper communication and identifying training requirements within the team.
Strictly applies reporting manager’s Claims directions.
Assistant Operations Manager
Vidal Health Insurance TPA Pvt. Ltd
Bengaluru
10.2021 - 05.2023
- Gained significant exposure to US healthcare operations, including claims management, insurance processes, and international client servicing.
- Collaborated with cross-border teams to align practices with US healthcare standards.
- Strengthened expertise in medical claims, compliance, and quality assurance related to US healthcare.
- Monitor and manage the escalation grievance team, ensuring timely resolution of issues.
- Conduct empanelment of hospitals and renewals, negotiating agreements and ensuring compliance.
- Coordinate with healthcare providers on pre-authorization and address hospital queries.
- Manage network list management in various portals, maintaining accuracy and compliance.
- Perform hospital outstanding reconciliation and ensure performance evaluation of network hospitals.
- Prepare and analyze internal and external reports, providing insights for decision-making.
- Develop induction training and standard operating procedures (SOPs) for team members.
- Mentor a team of 150 in insurance claims processing, ensuring accuracy and adherence to timelines.
- Handle hospital empanelments and address hospital grievances related to payments and settlements.
In patient Manager
Columbia Asia Hospital Whitefield
Bengaluru
09.2019 - 10.2021
Team Leadership & Government Engagement
Columbia Asia Hospital Whitefield
Bengaluru
09.2019 - 10.2021
Senior Medical Officer
Medsave Healthcare Insurance TPA Pvt. Ltd
Bengaluru
04.2017 - 09.2019
- Counsel hospital stakeholders on insurance expectations and requirements, fostering positive relationships.
- Monitor quality of insurance processing by the team and conduct regular training sessions for improvement.
- Coordinate with doctors on pre-authorization and assist hospitals in understanding insurance policies.
- Ensure compliance with agreements and validate package applications for specified cases.
- Assist doctors in understanding insurance costing and monitor insurance processing for accurate billing.
- Lead Quality Improvement Project of Discharge to streamline patient discharge processes.
- Coordinate with internal teams to ensure timely conversion of patients from insurance to self-pay.
- Scrutinize reports related to billing, revenue cycle management, and account receivables for accuracy.
- Coordinated workflows and delegated tasks for bill checking, posting and credit note processes.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Attended team meetings to discuss issues, priorities and outstanding accounts, improving department operations.
- Tracked and chased unsettled account balances, providing reports and findings to inform management.
- Analysed billing procedures to evaluate backlogs and identify opportunities for improved efficiency.
- Developed strong professional rapport with vendors and clients, fostering timely payments.
- Supervise inpatient occupancy and handle COVID occupancy, ensuring compliance with standards.
- Liaise with government officials for bed allocation and implementation of COVID protocols.
- Audit outstanding and short collection reports, taking appropriate actions for resolution.
- Manage recoveries from third-party administrators and patients, ensuring high levels of patient satisfaction.
- Process corporate and retail claims, detecting fraudulent claims and ensuring compliance.
- Train team members on policies, procedures, and quality checks to improve performance.
Senior Medical Officer
RMS Insurance Brokers Pvt. Ltd
Bengaluru
12.2016 - 05.2017
Medical Officer
MediAssist TPA Pvt. Ltd
Bengaluru
11.2015 - 12.2016
Dentist
Dhanvantri Dental Clinic
Bengaluru
Intern Dentist
DAPMRV Dental College & Hospital
Bengaluru
Education
Data Science Course -
08-2025
MBA - Operations Management in Healthcare
Dr. D. Y. Patil Vidyapeeth
Pune08-2023
Bachelor of Dental Science -
Rajiv Gandhi University
UN Information Test Certificate -
United School Organization of India
Skills
- Patient care and counseling
- Healthcare management and administration
- Network and insurance management
- Report generation and auditing
- Cost and revenue cycle management
- Team leadership and training
- Project management
- Client servicing and relationship management
- US Healthcare
Accomplishments
- Participated in FDI conference as a delegate in Delhi '14
- Participated in the CDE program on Oral cancer in Jun '15 and Feb 'XX
- Have successfully led quality improvement project for discharge and estimation in hospital.
Hobbies and Interests
Animal Welfare Advocate: Passionate about spreading awareness and caring for stray animals, actively involved in volunteering and providing food, shelter, and medical assistance.
Languages
- Hindi, First Language
- English, First Language
Timeline
Operations Manager
The Cigna Group
01.2025 - Current
Assistant Network Manager
Vidal Health Insurance TPA Pvt. Ltd
05.2023 - 12.2025
Assistant Operations Manager
Vidal Health Insurance TPA Pvt. Ltd
10.2021 - 05.2023
In patient Manager
Columbia Asia Hospital Whitefield
09.2019 - 10.2021
Team Leadership & Government Engagement
Columbia Asia Hospital Whitefield
09.2019 - 10.2021
Senior Medical Officer
Medsave Healthcare Insurance TPA Pvt. Ltd
04.2017 - 09.2019
Senior Medical Officer
RMS Insurance Brokers Pvt. Ltd
12.2016 - 05.2017
Medical Officer
MediAssist TPA Pvt. Ltd
11.2015 - 12.2016
Dentist
Dhanvantri Dental Clinic
Intern Dentist
DAPMRV Dental College & Hospital
Data Science Course -
MBA - Operations Management in Healthcare
Dr. D. Y. Patil Vidyapeeth
Bachelor of Dental Science -
Rajiv Gandhi University
UN Information Test Certificate -
United School Organization of India