Vishal Ahire

Seasoned business development professional with proven success in expanding Retail and GMC portfolios across regions. Skilled in driving strategic initiatives, managing sales operations, and collaborating with cross-functional teams to deliver high-impact insurance solutions. Strong relationship builder with deep expertise in partner engagement, regulatory compliance, and customer-centric service delivery.

• Developed and executed strategic initiatives to grow Retail & GMC business across assigned regions.
• Built and nurtured relationships with key brokers, agents, and corporate clients
• Managed end-to-end sales operations, including channel development, partner engagement, and customer acquisition
• Collaborated with underwriting, product, and marketing teams to design competitive offerings
• Monitored performance metrics, ensured target achievement, and implemented corrective measures
• Ensured regulatory compliance, operational efficiency, and high-quality customer service delivery

Dynamic and result-driven professional currently leading the newly established GMC & Retail Portfolio Vertical. Skilled in managing retail insurance portfolios nationwide, fostering strong relations with insurance and broker networks, and consistently driving revenue growth. Adept at strategic leadership, team management, and unlocking new business opportunities through market insight and collaboration.

• Strong presence and network within the insurance and broker market
• Leading the GMC & Retail Portfolio Vertical within the organization
• Strategizing to maintain and grow company revenue
• Managing retail portfolios of major insurance companies across India
• Building and maintaining strong relationships with top management of insurance firms
• Demonstrating excellence in team leadership and performance management
• Broker relations management and exploring new business opportunities

Experienced healthcare network operations professional with a strong background in managing hospital relations, resolving grievances, maintaining efficient cashless operations, and ensuring network expansion through strategic empanelment and retention. Proven ability to lead multi-TPA coordination, drive operational efficiency, and maintain compliance with documentation and pricing protocols.

• Interaction with Hospitals/Clients/TPAs to resolve grievances, especially payment-related issues
• Reconciliation of outstanding statements with network hospitals
• Retention and operational efficiency with empaneled hospitals
• Effective information management of cashless claims with hospitals
• Hospital empanelment, renewal, and retention for network expansion
• Maintenance of documentation and MOUs with hospitals
• Negotiation and upkeep of package prices/discounted tariffs for all active hospitals
• Leadership in handling and guiding operations of 14 TPA network units

Corporate Relations with a strong background in retail health insurance operations, claims coordination, and client servicing. Skilled in handling employee queries, ensuring timely TATs, and identifying additional revenue opportunities while maintaining efficient communication with corporates and insurers.

• Facilitated communication for feedback from insurers and corporate clients.
• Identified additional revenue opportunities from existing corporate relationships.
• Maintained weekly reports on claims, queries, and resolution TATs.
• Expedited claims processing by recovering deficiency documents.
• Escalated unresolved issues per defined escalation matrix.

Results-driven claims professional with strong expertise in end-to-end claims management, client coordination, and MIS analysis. Skilled in resolving escalations, ensuring timely claim settlements, and maintaining seamless communication across internal and external stakeholders.

• Managed comprehensive claims processes, overseeing file reviews and ensuring compliance.
• Prepared and analyzed detailed Claims MIS reports for strategic decision-making.
• Coordinated communication among corporates, brokers, IMDs, clients, and TPAs to enhance collaboration.
• Ensured recovery of deficiency documents to facilitate smooth claims processing.

Detail-oriented claims management professional with hands-on experience in handling reimbursement and direct billing claims, TPA coordination, and client communication. Proficient in claim approvals, email correspondence, and insurance file processing, while ensuring smooth operations and timely resolutions.

• Managed all reimbursement and direct billing claims end-to-end.
• Handled claim approvals received from TPAs and hospitals.
• Responded to 75–100 queries daily via email from TPAs, brokers, and clients.
• Maintained comprehensive claims tracker (reimbursement, direct billing, medical death).
• Extracted utilization reports and beneficiary lists for Sales/Operations.