SANTHOSHKUMAR A
Salem
Summary
Experienced Insurance Operations Professional with 13+ years in hospital insurance billing, claims management, and payer coordination. Proven ability to manage end-to-end insurance functions, reduce claim denials, and improve reimbursement cycles. Strong expertise in handling government schemes, TPAs, and private insurers. Skilled in team leadership, audit compliance, and revenue optimization. Seeking a role as Insurance Manager to drive operational efficiency and maximize insurance collections.
Overview
16
16
years of professional experience
Work History
Insurance Manager
Salem Polyclinic Private Ltd
Salem
05.2026 - Current
- Lead and manage the overall insurance department operations, including cashless and reimbursement claims.
- Coordinate with TPAs, insurance companies, and corporate clients for smooth claim processing and settlements.
- Monitor pre-authorization, claim submission, follow-up, and denial management activities.
- Ensure compliance with insurer guidelines, hospital policies, and audit requirements.
- Prepare MIS reports, revenue analysis, and insurer-wise performance reports for management review.
- Supervise insurance and billing teams to improve operational efficiency and patient satisfaction.
- Handle empanelment, contract renewals, and relationship management with insurance partners.
- Implement process improvements to enhance claim approval rates and reduce turnaround time.
Assistant Insurance Manager
Shanmuga Hospital Ltd.
Salem
11.2016 - 04.2026
- Manage complete insurance operations, including cashless and reimbursement claims.
- Handle empanelment, MOUs, and renewals with CMCHIS, ECHS, ESI, Railways, and private insurers.
- Oversee pre-authorization, eligibility verification, and approval processes.
- Monitor claim lifecycle from submission to settlement, ensuring timely reimbursements.
- Analyze claim denials and implement corrective actions to reduce rejection rates.
- Coordinate with insurers/TPAs for escalations and quick resolution of issues.
- Supervise and guide insurance and billing teams to improve accuracy and productivity.
- Ensure compliance with insurance policies, documentation standards, and audit requirements.
- Prepare MIS reports, insurer-wise performance data, and revenue summaries.
Insurance Executive
Shanmuga Hospital & Salem Cancer Institute
Salem
06.2012 - 06.2016
- Processed insurance claims for IP and OP patients.
- Coordinated with TPAs and insurers for approvals and clarifications.
- Prepared documentation for cashless and reimbursement claims.
- Ensured accurate and timely submission of claims.
Technical Support Executive
United Data Service
Salem
07.2010 - 11.2012
- Managed system operations, data backups, and troubleshooting.
- Supported hospital-related software and data systems.
Education
Bachelor of Computer Applications (BCA) -
AVS College of Arts & Science
Salem01.2010
HSC -
Gokulnatha Hindu Maha Jana Hr.Sec.School
Salem01.2007
SSLC -
Appollo Matriculation School
Salem01.2005
Skills
- Insurance Operations Management
- Claims Processing & Reimbursement
- Pre-Authorization & Eligibility
- Denial Management & Appeals
- TPA / Corporate / Government Schemes
- Cashless & Reimbursement Handling
- Billing Compliance & Audit
- Team Supervision & Training
- MIS Reporting & Analysis
KEY ACHIEVEMENTS
- Reduced claim rejection through improved documentation and verification.
- Increased insurance collection efficiency and reduced delays in settlement.
- Successfully managed multiple insurer accounts with consistent performance.
- Maintained strong relationships with TPAs and insurance partners.
Technical Skills
- MS Excel (Reports, MIS, Data Analysis)
- Hospital Billing & Insurance Software
- MS Word, PowerPoint, Outlook
- Basic Networking & System Support
Custom Section
- Insurance Manager
- Billing Manager
- Hospital Operations Executive
- Revenue Cycle Manager
Personal Information
Passport Number: V7350463
Languages
Tamil
Proficient
C2
English
Upper Intermediate
B2
Timeline
Insurance Manager
Salem Polyclinic Private Ltd
05.2026 - Current
Assistant Insurance Manager
Shanmuga Hospital Ltd.
11.2016 - 04.2026
Insurance Executive
Shanmuga Hospital & Salem Cancer Institute
06.2012 - 06.2016
Technical Support Executive
United Data Service
07.2010 - 11.2012
Bachelor of Computer Applications (BCA) -
AVS College of Arts & Science
HSC -
Gokulnatha Hindu Maha Jana Hr.Sec.School
SSLC -
Appollo Matriculation School