DR URMI ROY
Bangalore
Summary
Dedicated to optimizing health insurance operations, I bring extensive experience as an Insurance Manager with a focus on enhancing efficiency and patient satisfaction. Throughout my career, I have implemented innovative strategies to streamline processes, reduce turnaround times, and ensure seamless interactions for policyholders. Leveraging automation technologies and fostering strategic partnerships with insurance providers, I consistently exceed expectations in delivering results. My proactive problem-solving approach and commitment to professional development, evidenced by enrollment in the NH MBA Program by IIMBX and completion of Six Sigma Green Belt Certification, underscore my dedication to driving excellence in health insurance management. With a passion for innovation and a proven track record of success, I am ready to make a transformative impact on your organization's health insurance operations.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Manager
Narayana Health
BENGALURU
10.2021 - Current
- Professional Summary: Dedicated and results-driven Insurance Manager with extensive experience in managing insurance operations and corporate relations in the healthcare industry. Proven track record of implementing process improvements, reducing TAT, and enhancing operational efficiency. Skilled in building strong relationships with TPAs and insurance stakeholders to resolve escalations and ensure seamless patient experiences.
- Key Responsibilities and Achievements:
- Managed Pre-auth team and admission teams, resolving escalations and issues related to insurance patients through proactive relationship management with various TPAs and insurance stakeholders.
- Spearheaded system automation initiatives, reducing discharge TAT by half and minimizing manual work through auto-filled claim forms and end-to-end claim processing automation.
- Implemented paperless initiatives for the Admission and Claim submission team, leveraging system automations and agreements with TPAs for online claim submission.
- Led the adoption of Claim Book processing software for all Pan India units, enhancing operational efficiency and accuracy.
- Collaborated with the IT team to evolve the Aathma system, ensuring seamless documentation processing for claims and hospitalizations.
- Introduced the Claim Maker Checker Initiative, implementing an audit mechanism for insurance claims, resulting in reduced errors and queries.
- Conducted Service Excellence training for front desk, claim submission team, and billing staff across Pan India locations, exceeding performance expectations.
- Enrolled in the NH MBA Program by IIMBX and completed Six Sigma Green Belt Certification, demonstrating a commitment to professional development and exceeding performance expectations.
- Demonstrated proficiency in handling escalations and delayed approvals, ensuring customer satisfaction and exceeding performance expectations.
- Successfully integrated Oracle for data reconciliation, meeting minimum performance expectations in data management and reconciliation.
- Conducted audits of bills and claims submissions, ensuring regulatory compliance and adherence to standards.
Manager - Concurrent Audit Team (Risk Team
Vidal Healthcare TPA.
09.2019 - 10.2021
- Managed a team of 6 auditors overseeing in-house production quality, resulting in error reduction and avoidance of external recovery.
- Coordinated interdepartmentally and communicated common errors to senior management for corrective action.
- Conducted training sessions for operations staff to enhance efficiency and minimize errors, staying updated on insurer guidelines and SLAs.
- Oversaw external audits conducted by stakeholders, ensuring timely response to findings and minimizing recovery amounts.
- Educated processing teams on audit findings to prevent future recoveries, utilizing data for internal audits and budgeting purposes.
- Provided medical opinions for investigation claims and ombudsman cases, aiding in fraud detection and justifying TPA actions.
- Offered claim admissibility opinions for high-value cases, reducing processor errors in significant claims.
- Liaised with network teams to address hospital disparities and pre-authorization issues promptly.
- Facilitated the provision of requested data to stakeholders in accordance with their requirements.
Medical Manager
MD India Healthcare TPA
09.2017 - 10.2019
- Supervised a team of MBBS doctors, ensuring adherence to medical protocols and standards.
- Provided expert medical opinions to determine the admissibility of claims, maintaining accuracy and compliance with regulatory guidelines.
- Spearheaded web development initiatives for claim adjudication from a medical perspective, facilitating error-free processing and enhancing system efficiency.
- Implemented system enhancements for improved claims adjudication, such as the integration of ICD and PCS codes, ensuring precision and effectiveness.
- Provided guidance to the IFD (Fraud Detection) team on medically related claim frauds, contributing to fraud prevention efforts.
- Conducted analysis of fraudulent hospitals to identify patterns and mitigate fraudulent activities effectively.
- Implemented ICR (Incurred Claims Ratio) reduction plans through proper claim adjudication and provided medical opinions for OMBUDSMAN claims, ensuring fair and accurate claim resolution.
- Conducted medical training sessions for processors to enhance their knowledge and skills, ensuring adherence to medical standards and best practices.
- Led the development of mobile applications to streamline processes and improve accessibility for stakeholders.
Medical resident- ent department
Bharti Vidyapeeth medical college
01.2014 - 01.2016
- Writing prescriptions carrying out basic ent procedures such as wax removal, tracheostomy tube suctioning and cleaning, suturing, nasal douching, dressing, nasal pack, etc
- Performing basic duties such as bp, sugar,temp etc Handling the diagnosis, treatment, and referrals for patients
- Assisted in several life-saving procedures
- Managed the out patient nursing staff
- Filed monthly patient diagnosis forms to insurance claims.
Education
Six Sigma - Green Belt -
Lean Pro Six Sigma
Bengaluru02-2023
Health Management Certification -
IIM BX Banglore
01.2023
Mbbs -
Bharti Vidyapeeth Medical College
01.2013
A' level -
St mary School Dubai
01.2006
Skills
- Insurance Operations Management
- Relationship Management
- Process Improvement
- System Automation
- Claims Processing
- Training and Development
- Regulatory Compliance
- Data Reconciliation
- Escalation Handling
- Strategic Planning
- Team Leadership
- Communication Skills
- Problem-Solving
- Attention to Detail
- Multitasking
- Microsoft Office Suite
- Healthcare Industry Knowledge
- Customer Service
- Risk Analysis
- Willing to Learn
- Data Analysis
Passport
Indian
Hobby
Dancing Movies Art
Known Languages
- English
- Hindi
- Bengali
- Urdu
- Arabic
Personal Information
- Title: Medical Manager
- Date of Birth: 04/30/1987
- Nationality: Indian
- Marital Status: Married
References
- T.S Meenakshi - Project Head Finance digitization
- E Utthra - IT manager
- Pratap - Claim DM
- Tahir - Admission manager
- Meenu Dhir, AGM Risk – Vidal Health Tpa
- Anitha, Sr. Manager – Investigation team- Vidal Health Tpa
- Dr Banumathy, CMO- Vidal Health Tpa
- Dr Nilopher Naikwadi-Shaikh, Medical manager, Mdindia Tpa health insurance
- Mr Vinod Kumar, Assistant General Manager, MDindia Tpa
- Dr Divya Nayyat, Claims manager, MDindia TPA
Hobbies and Interests
- Healthcare
- Technology
- Artificial intelligence
- Dancing
- Movies
- History
Affiliations
- Healthcare Innovation: Exploring cutting-edge technology to improve healthcare.
- Artificial Intelligence: Fascinated by AI's potential in various fields.
- Dancing: Passionate about expressive movement and diverse dance styles.
- Movies: Enjoys exploring diverse cinematic experiences.
- History: Intrigued by the richness of the past and its relevance today.
- Art-Tech Fusion: Inspired by the fusion of art and technology.
Languages
English
First Language
Hindi
Intermediate (B1)
B1
Bengali
Beginner
A1
Certification
- Hospital Management from IIM Banglore
- Lean Six Sigma - Green Belt
- Excel training
- Management Training
- Fire and security Training
- Masterclass in healthcare Analytics
References
References available upon request.
Timeline
Insurance Manager
Narayana Health
10.2021 - Current
Manager - Concurrent Audit Team (Risk Team
Vidal Healthcare TPA.
09.2019 - 10.2021
Medical Manager
MD India Healthcare TPA
09.2017 - 10.2019
Medical resident- ent department
Bharti Vidyapeeth medical college
01.2014 - 01.2016
Six Sigma - Green Belt -
Lean Pro Six Sigma
Health Management Certification -
IIM BX Banglore
Mbbs -
Bharti Vidyapeeth Medical College
A' level -
St mary School Dubai
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