Ravikumar M
Bangalore
Summary
Results-oriented insurance professional with 12+ years of experience across accident, health, and property & casualty (P&C) sectors, offering expertise in multiple geographies. A subject matter expert in claims operations, underwriting, product design, KPI management, and process optimization. Proven ability to lead teams, improve operational efficiency, and implement cost-reduction strategies. Skilled in claims management, vendor oversight, client relations, and regulatory compliance. Adept at leveraging data-driven insights to drive innovation and deliver superior results in complex, multi-regional environments. Experienced in leading transformation initiatives and ensuring high performance through strategic process improvements and enhanced customer satisfaction..
Overview
13
13
years of professional experience
1
1
Certification
Work History
Sr. Manager - Claims Internal Process Controller, Claims-CoE.
Acko General Insurance Limited
Bangalore
08.2021 - Current
- Developed and updated SOPs in accordance with regulatory guidelines and process changes to ensure ongoing compliance with industry standards.
- Set weekly KPIs, drive staff motivation, and surpass performance goals, while creating a performance dashboard for transparent and objective evaluations.
- Led Close File Review (CFR) activities, overseeing audits, training initiatives, and regulatory compliance to enhance customer satisfaction and operational effectiveness.
- Conducted Root Cause Analysis (RCA), formulated corrective action plans, and tracked progress to address process gaps, and improve operational efficiency.
- Designed and implemented targeted training programs to bridge knowledge gaps, and ensure adherence to departmental guidelines and regulatory requirements.
- Recommended and implemented process improvements to boost team performance, quality, and service levels.
- Collaborated with Underwriting, Risk & Compliance, and Technology teams to implement controls, and ensure regulatory adherence across business functions.
- Led vendor management, including contract negotiations, SLA management, and conducting regular performance reviews.
- Assessed systems requirements, developed BRDs and PRFAQ documents, facilitated testing (UAT), and validated production environments.
- Implemented a comprehensive KYC validation framework across the organization, ensuring 100% compliance within the claims process.
- Managed senior management reporting, presentations, and stakeholder relations to ensure alignment with business objectives and priorities.
- Ensured regulatory compliance within the claims process, while implementing fraud detection strategies in collaboration with legal and investigative teams.
- Collaborated with cross-functional teams to define project objectives, scope, and priorities, ensuring alignment with organizational goals, and delivering results on time.
- Directed ad hoc regulatory initiatives, coordinating cross-functional teams to meet deadlines, and ensure compliance.
- Instrumental in managing internal and external audits, with no major observations.
Manager - Claims Internal Process Controller, Claims-CoE.
AXA Business Services Pvt. Ltd
Bangalore
08.2021 - 09.2023
- Standardized key process documents, including Claims Manuals, QA & Audit guidelines, and policies (e.g., Underwriting, Ex-gratia, Rejection processes) at both departmental and organizational levels
- Optimized documentation management by leveraging cloud storage and SFTP for secure data handling and seamless data exchange with external partners
- Led API integration between the mobile app and TPA system, boosting efficiency by 3 FTEs through cross-functional collaboration
- Worked with vendors to implement real-time payment automation via a penny drop mechanism, reducing settlement TAT and improving NPS scores
- Automated the creation of Dummy UHIDs for NIDB claims, enhancing reserve management and operational control while improving financial outcomes
- Resolved issues efficiently using strong problem-solving strategies and provided constructive feedback to improve team performance
- Ensured timely adherence to regulatory guidelines, confirming compliance within required timelines
Associate Manager - New Business & Policy Admin & UW(Operations)
AXA Business Services Pvt. Ltd
Bangalore
07.2019 - 08.2021
- Successfully managed a Health and P&C Operational team with size of 60+ for the Singapore region, and oversaw various Lines of Business (Commercial lines, Motor, Marine, Health and Bancassurance)
- Led recruitment, hiring and onboarding activities, training new joiners in operational processes and conducting probationary performance reviews
- Set and monitored SLAs and KPIs to achieve department targets
- Monitoring the overall functioning of processes, identifying improvement areas, and implementing adequate measures to maximize customer satisfaction
- Worked collaboratively with cross-functional teams (including client representatives) to analyze requirements (changes in existing processes and workflows), identify solutions and plan for process transitions or migrations
- Successfully migrated multiple projects from various areas of Health care and P&C
- Framing work direction & plan for associates after assessing capabilities, also setting up targets, SOP & SLA, maintaining CTQ (Critical to Quality) / CTP (Critical to Process) targets while planning the process
- Delivered exceptional customer service to grow business, resolve issues and maximize customer experience
- Developed Performance management tools based on the number of risks to Commercial lines policies, providing the accurate standard time to measure against the actual time of processing
- Managed all client inquiries through a resolution to enhance customer satisfaction ratings
Team Lead
AXA Business Services Pvt. Ltd
Bangalore
08.2017 - 06.2019
- Acted as Single Point of Contact (SPOC) for Health & Commercial lines policies-related queries and escalations
- Successfully met KPIs for each team member, including Average Handling Time (AHT), Quality metrics, Productivity, Performance, Adherence to Schedule, Shrinkage, Attrition, and Compliance Audit
- Managed a team of 20 Full-Time Equivalents (FTEs) responsible for Commercial lines and Health insurance policy administration (Singapore region)
- Compiled claims reports for insurance companies and executed process optimizations, reducing FTEs by 2 in Q1 2019
- Reviewed and validated insurance applications and documents for accuracy, ensuring all necessary information was collected to assess claim validity
- Communicated with policyholders, healthcare providers, and relevant parties to obtain missing information for claims processing
- Analyzed insurance claims to determine the insurance company’s liability, coordinated with adjusters, agents, and investigators for additional clarification
- Kept claim files organized and updated, documenting all actions and decisions taken
- Created and delivered training modules based on policy guidelines and insurance products
- Validated large premium policies referred by the team and guided them toward accurate processing, ensuring customer satisfaction and business expansion
- Conducted Quality Management System (QMS) and Information Security Management System (ISMS) audits at the organizational level
Team Lead
AXA Business Services Pvt. Ltd
Bangalore
08.2016 - 06.2017
- Successfully managed a team of doctors and paramedic professionals with a team size of 25+, including the various health insurance verticals in the Gulf region
- Experts in Health insurance management have experience in the entire lifecycle of Health insurance, including Policy administration, Pre-authorization, and Claims settlement
- Acted as a single point of contact for Health & Commercial lines policies-related queries and escalations
Subject Matter Expert- Heath Claims
AXA Business Services Pvt. Ltd
Bangalore
08.2012 - 07.2016
- Worked in multiple roles (Associate, Analyst, Specialist & SME) in Health insurance claims processing for analyzing and Processing insurance claims in a timely and accurate manner in accordance with Claims policy and regulatory guidelines
- Worked on electronic claims (DHA and HAAD) with stringent guidelines on various medical procedures
- Handling the medical claims approvals/assessment based on medical eligibility and policy terms, and reconciliation of outpatient and inpatient claims
- Conducting training on medical adjudication and claim processing
- Have extensive expertise in Reimbursement (RI) Claims
- Expert in processing Preauthorization Claims, E-claims, Reimbursement, and handling reconciliations
- Back up for process leader for work allocation, quality analysis, and monthly reports
- Created an Excel-based RI calculation sheet to manage the complex claims involving treatment in multiple countries (different currencies), and hospitals with different regional & customary charges as applicable
Lecturer
Smt. Nagarathnamma College of Nursing (A Unit of Acharya Group of Institutions)
Bangalore
08.2011 - 06.2012
- Demonstrate nursing procedures, supervise students, and guide them in classroom and clinical setups towards higher professional standards
- Prepared and taught topics such as pharmacology, Mental health nursing, and Community health care practices
- Collaborated with QUICAI (Quality Implementation Cell Acharya Institutes) as a Quality Cluster member towards achieving NAAC Accreditation
- Acted as NSS Programmer Officer during the tenure representing the Acharya Institutions & conducted various Health Awareness programs
Education
Masters - Community Health Nursing
Rajeev Gandhi University of Health Sciences
Bangalore01.2011
Bachelor of Science - Nursing
Rajeev Gandhi University of Health Sciences
Bangalore01.2007
Skills
- Process/Service Operations Management
- Team leadership
- Business strategy
- Project management
- Process Automation
- Regulatory Compliance
- Claims Management
- Policy/Manual/SOPs creation
- Cross-Functional Collaboration
- Process Improvements
- Performance management
- Quality Assurance
- Investigation & Fraud Detection
- Fraud prevention & Blacklisting
Certification
- Licentiate from Insurance Institute of India
- Lean Six Sigma Green Belt from AXA BS Services Pvt Ltd.
- Lead Auditor Training for QMS & ISMS
- Trained in fire Prevention & Fire Fighting, Basic Life Support From 'When It Strikes Crisis Management Pvt.Ltd.'
- Trained And Effectively Functioned As ERT(Emergency Response Team) Lead For Coordinating The Safety Of Employees And Managing The BCP during The Crisis Situation.
Accomplishments
- 12/20, Received 'Crisis Superstar Award' for the support extended in managing the BCP situation in 2020 at the organization level during the pandemic.
- 12/20, Received client appreciation for clearance of a huge volume surge with effective resource planning and cross-training.
- 12/20, Received Best Assistant Manager Award for the year 2020.
- 12/18, Received Best Process Leader award for the year 2018.
- Multiple Migrations through gaining the client's trust and effective team coordination.
- Executed Process optimization and automation, which resulted in improving 5 FTE.
- Achieved high NPS scores through customer delight by effective resource planning and management.
- Multiple Migrations through gaining the client's trust and effective team coordination.
- Executed Process optimization and automation, which resulted in improving 5 FTE.
- Achieved high NPS scores through customer delight by effective resource planning and management.
- Multiple Migrations through gaining the client's trust and effective team coordination.
- Executed Process optimization and automation, which resulted in improving 5 FTE.
- Achieved high NPS scores through customer delight by effective resource planning and management.
Projects
- I headed the automation of the CKYC process in collaboration with e-Mudhra and CERSAI, India, at Acko.
- Jarvis – Claims dashboard and end-to-end claim processing system
- Cashfree integration, GBQ portal for payments and reconciliations
- Vendor portal specifically for the hospitals, medical experts and investigators.
- Health claims integration with TPA systems including network hospitals
- Health Claims Migration to inhouse
- International Travel & Medical claims assistance onboarding Communication templates standardization
- Migration of Commercial lines (Singapore) policy administration
- Integration of email to case via Sales force
Languages
- Kannada, First Language
- English, Proficient
- Hindi, Proficient
Timeline
Sr. Manager - Claims Internal Process Controller, Claims-CoE.
Acko General Insurance Limited
08.2021 - Current
Manager - Claims Internal Process Controller, Claims-CoE.
AXA Business Services Pvt. Ltd
08.2021 - 09.2023
Associate Manager - New Business & Policy Admin & UW(Operations)
AXA Business Services Pvt. Ltd
07.2019 - 08.2021
Team Lead
AXA Business Services Pvt. Ltd
08.2017 - 06.2019
Team Lead
AXA Business Services Pvt. Ltd
08.2016 - 06.2017
Subject Matter Expert- Heath Claims
AXA Business Services Pvt. Ltd
08.2012 - 07.2016
Lecturer
Smt. Nagarathnamma College of Nursing (A Unit of Acharya Group of Institutions)
08.2011 - 06.2012
Masters - Community Health Nursing
Rajeev Gandhi University of Health Sciences
Bachelor of Science - Nursing
Rajeev Gandhi University of Health Sciences
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