Rakesh Ahirwar

Experienced senior manager in the insurance industry with 15 years of expertise in claims processing and risk management. Consistently achieved 100% compliance with service level agreements and quality standards. Promoted to senior manager in 2022-23 and awarded champion status in 2021-22 for exceptional contributions. Skilled in overseeing operations and ensuring fulfillment of all contractual obligations.

• Custer services, Insurance need and Risk Management, TAT Analysis at ICICI Lombard GIC.
• CGMP,EHS training activities conducted by IPCA Ltd. Ratlam.
• First Aid Training.
• Professional Training (15 Days) at Lupin Ltd. Mandideep, District Raisen(M.P.) 2007-2008.
• Title: Solid & Liquid Dosage Formulation
• Firm: Panacea Biotech. Baddi, Dist- Solan (H.P)

• Currently working profile-
• In Insurance Sector(Current Profile): Operation Management(Claims), Risk Management, Senior Consultant/Claims analyst, Work assignment and team Management - Personal Accident Insurance Claim Settlement Technical QC process- as a CSM(GPA, WC, IPA,SMC, Loan Cards product, PA Motor, LOJ Claims etc settlement).
• Purpose of the role
• Responsible for transaction processing, operations & quality compliance
• Key Responsibilities -
• Handling Claim settlement (Final Quality Check)
• Co-Ordination with MO, Client
• Co-Ordination with ICLM , CRM, UW & other Processing Team
• Team meeting
• Training about the product & processing
• SOP, Reports, Analysis on Quality
• Job Description -
• Ensure 100% SLA/TAT adherence and Quality Compliance
• Ensure 100% delivery of all contractual obligations, regulatory and statutory requirements
• Recommend and establish new/optimized processes and reporting methods to improve overall operational efficiency
• Track Workflow, Team utilization, Job progress, Seat utilization
• Responsible for policy servicing & operations
• Monitor the Workflow processes and adjust schedules as needed
• Supervise and motivate team members
• Review operator performance, set new standards and administer incentive programs
• Design, develop and deliver new processes
• Evolve new report/dashboard templates, data capture mechanisms, reporting methods
• Responsible for policy servicing & customer service right from inward to policy delivery
• Provide insight and recommendations based on qualitative and quantitative data.
• Overseeing commercial underwriting issue viz., scrutiny of proposal, underwriting of the proposal and the issuance process.
• Ensured compliance of various quality measures by maintaining requisite documentation/ records. Writing/reviewing detailed documents like process and validation protocols.
• Review, tabulate and analyzes data through a variety of operational and production reports using existing tools.
• Examine the data recognizing exceptions deviations and trends and immediately share the findings and actions with the supervisor

• Cashless claims and Reimbursement claims settlement processing.
• JOB PROFILE(in Cashless):
• Handling preauthorization letter, hospital reports, customer documents, approval mails etc.
• Quality check
• Give Authorization no.
• Maintain TAT & files movement
• Team meeting

• Logical Thinking.
• Good concept developer and critic.
• Effective Communication skill.
• Friendly nature.
• Sincere and smart to work.
• Quickly adopt the work culture of organization.
• Sincere dedication towards job assignment.
• Always endeavor to perform my best and to the maximum of my capability.