MONI M CHAKRAVARTY

• Increase reach and market share by adding new clients in the desired segment to the Organization’s portfolio
• Achieve financial targets articulated in the strategic plans of the Organization in terms of the brokerage earned through
• Review of the coverages under existing policies and other areas of risk coverage
• Relationship building with the insurance companies and surveyors to ensure optimum claim settlement in minimum time
• During the processing of the claim analyze the following and communicate to underwriters: adequacy of the sum insured, risk improvement, anomalies in the policy, scope of additional policies
• Increase reach and market share by adding new clients in the desired segment to Organization.

• Operations, Risk Management and claim management, Underwriting, Miscellaneous Insurance,
• Holds the credit of rating complex risks like power, petrochemicals and other large projects
• Managed automation and advanced reporting of insurance data.

Regulatory Knowledge: Staying updated on federal, state, and local health insurance regulations (e.g., ACA, HIPAA).

Policy Implementation: Developing and implementing policies that align with regulatory requirements. Compliance Audits: Regularly conducting internal audits to ensure compliance with all legal and regulatory standards.

Claims Processing: Overseeing the accurate and timely processing of claims, including adjudication, payment,

Fraud Detection: Implementing systems to detect and prevent fraudulent claims.

Customer Service: Ensuring claimants receive clear communication and assistance throughout the claims process.

Contract Negotiations: Negotiating contracts with healthcare providers, ensuring competitive pricing, and managing relationships.

Network Adequacy: Ensuring the insurance plan provides adequate access to healthcare services for policyholders.

Quality Assurance: Monitoring the quality of care provided by network providers and addressing any issues.

Risk Assessment: Evaluating the risk associated with insuring individuals or groups and setting appropriate premium rates.

Premium Pricing: Developing pricing models that balance competitiveness with profitability.

Reinsurance: Managing reinsurance contracts to mitigate the risk of large claims.

Enrolment Services: Managing enrolling individuals and groups into health insurance plans.

Member Education: Providing resources and education to help members understand their benefits and how to use them.

Issue Resolution: Handling member inquiries, complaints, and appeals efficiently.

Budgeting and Forecasting: Creating financial plans that ensure the long-term sustainability of the insurance plan.

Financial Reporting: Regularly reporting financial performance to stakeholders.

Cost Control: Identifying and implementing cost-saving measures without compromising service quality.

Health Information Systems: Utilizing advanced software and systems for claims processing, data management, and reporting.

Data Security: Ensuring the confidentiality and security of sensitive member information.

Analytics: Leveraging data analytics to improve decision-making, identify trends, and optimize operations.

Market Analysis: Conducting market research to identify trends, competitive positioning, and opportunities for new products.

Product Development: Designing and launching new insurance products or services based on market needs and regulatory changes.

Business Growth: Developing strategies for customer acquisition, retention, and overall business expansion.