Summary
Overview
Work History
Education
Skills
Timeline
Generic
Santhosh Kumar MD

Santhosh Kumar MD

Claim Investigator
Mangalore

Summary

Dynamic Claim Investigator and Team Lead with 5 years of experience at SKD Health Allied Services with expertise in insurance fraud and risk analysis. Proven track record in managing investigations and mentoring teams, ensuring accurate claims processing. Exceptional communication skills complement strong report generation abilities, driving efficiency and quality in service delivery.

Overview

13
13
years of professional experience
4
4
Languages

Work History

Claim Investigator - Team Lead

SKD Health Allied Services
10.2021 - Current

Achievements:
Initially joined as a Field Investigation Officer and subsequently promoted to Team Lead, currently overseeing the entire team in Mangalore, Udupi, and surrounding areas.

Roles and responsibilities:-

As a Field Investigation Officer:

Conducted thorough investigations for cashless claims, reimbursement claims, personal accident cases, motor accident claims, and bill verification.

Performed on-site assessments, evidence collection, and documentation to ensure accurate claim processing.


Collaborated with stakeholders to verify claims and resolve discrepancies efficiently.


Prepared detailed reports to support claim evaluations and decision-making processes.


As a Team Lead (Mangalore, Udupi, and surrounding areas):-

Lead and manage a team responsible for handling cashless, reimbursement, personal accident, motor accident, and bill verification processes.

Oversee operations, ensuring timely and accurate completion of investigations and claims processing.


Mentor and train team members to enhance performance and maintain high standards of service delivery.


Quality Control Inspector

JJGLASTRONICS
04.2017 - 09.2021

Roles and responsibilities:-


As a Quality Inspector:-

Determined quality improvement parameters by applying statistical methods relevant to manufacturing processes.

Maintained accurate documentation for auditing purposes, ensuring compliance with regulatory standards.

Prepared non-conformance reports and 8D corrective action reports to address quality issues.

Maintained calibration records and monitored operator downtime reports to optimize efficiency.


Prepared final inspection reports to ensure product quality and adherence to specifications.


Contributed to team objectives by delivering results as required.

Conducted inspections of incoming materials to verify quality standards.

Prepared rejection trend analysis charts to identify and address recurring issues.


Issued supplier Certificates of Conformance (CoC) for shipments.

Identified root causes of rejections using cause-and-effect diagrams for effective resolution.

Quality Control Inspector

Danatrol Engineering India Pvt Ltd
02.2013 - 04.2017

Graduate Engineer Trainee

Pricol Limited
02.2012 - 01.2013

Education

Bachelor of Technology - Mechanical Engineering

EINSTEIN COLLEGE OF ENGINEERING
Tirunelveli, India
04.2001 -

Skills

    Insurance fraud

    Data review

    Risk analysis

    Investigation management

    Investigative photography

    Records management

    Report generation

    Claims documentation

    Excellent communication

    Written communication

Timeline

Claim Investigator - Team Lead

SKD Health Allied Services
10.2021 - Current

Quality Control Inspector

JJGLASTRONICS
04.2017 - 09.2021

Quality Control Inspector

Danatrol Engineering India Pvt Ltd
02.2013 - 04.2017

Graduate Engineer Trainee

Pricol Limited
02.2012 - 01.2013

Bachelor of Technology - Mechanical Engineering

EINSTEIN COLLEGE OF ENGINEERING
04.2001 -
Santhosh Kumar MDClaim Investigator