HETAVI PANCHAL

• Oversaw end-to-end quality of claims processing by external vendors, ensuring adherence to organizational standards and compliance requirements.
• Monitored and improved TAT metrics to ensure timely and efficient claims settlement.
• Led timely communication and training for vendor teams on process updates and system enhancements.
• Conducted regular performance reviews and feedback sessions to drive continuous improvement in vendor service delivery.
• Approved 1000 plus Micro Claims up to 2 lakh limit.
• Conducted deduplication activities for PMJJBY by checking industry matches and processing claims accordingly.
• Demonstrated understanding of PMJJBY assessments and approvals, including retail evaluations.
• Have been rewarded for outstanding performance and streamlining the process in the month of May 2025

• Managed the end-to-end Retail-claims process, including claim intimation, registration, assessment and payment.
• Handling Critical illness cases from end-to-end correct process flow

• Managing High value cases, ensuring timely coordination with Reinsurer, sales, industry checks and requirements to meet the timely Closure.

• Analyzing trends and identifying areas for improvement, implemented strategies to enhance claims process efficiency

• Managed the end-to-end Pre-claims process, including claim intake, investigation and coverage analysis

• Developed and implemented claims handling procedures and best practices to streamline operations and improve efficiency

• Analysing trends and identifying areas for improvement, implemented strategies to enhance claims process efficiency

• Ensured compliance with regulatory requirements and company policies throughout the Pre-claims handling process

• Leading the End-to-End Payment activity

• Managing end-to-end IIB Process

• Co-ordination with Legal team for Litigation and Legal queries pertaining to claims and preclaims cases

• Handled Micro Group Claims and delivered timely decisions

• Managing B2B Clients. Managing their dashboard and business reports along with there queries pertaining to commission, product new scheme and plans as well as changes in dashboard etc

• Managed the end-to-end claims process, including claim intake, investigation, coverage analysis, settlement negotiation, and claim resolution

• Collaborated with internal departments and external vendors to facilitate claim resolution, including coordinate, inspections, obtaining expert opinions, and managing litigation when necessary

• Analyzing trends and identifying areas for improvement, implemented strategies to enhance claims process efficiency

• Examined claims forms and other records to determine fraudulent intention • Investigated claims involving potential and suspected fraudulent activities

• Maintained suspicious claims database and prepared reports on a monthly basis for supervisors

• Documented all investigation activity and presented reports to management

• Coordinating with MPH

• Handled complex and high-value claims, demonstrating and strong analyzing skills