Ravikumar M Email & Phone Number

Bengaluru, Karnataka, India

• Strategic KPI Formulation: Set weekly KPI targets to drive staff performance and exceed benchmarks. Create a performance dashboard with weighted criteria for transparent annual evaluations. Recommend and implement.
• Process Expertise, Control & Training: Act as a subject matter expert and in-house trainer with comprehensive product and process knowledge. Train colleagues to build team expertise, implement process controls for.
• Audit Management: Lead internal and external audits, ensuring thorough evaluation and compliance. Address and resolve audit findings to improve operational integrity and efficiency.
• Regulatory Compliance & KYC Management: Ensure compliance with regulatory guidelines and oversee KYC processes to meet regulatory requirements and mitigate verification risks.
• API Integration & Automation: Facilitate mobile app integration with TPA systems, resulting in a 3 FTE efficiency gain. Lead automation of Dummy UHIDs for NIDB claims, enhancing reserve management.
• Payment Automation & Stakeholder Collaboration: Implement payment automation using the penny drop mechanism, improving settlement turnaround times and NPS scores. Communicate with insured parties to resolve.

Bengaluru, Karnataka, India

• Process Standardization: Created and implemented standardized process documents for Claims, Quality Audits, and organizational policies, ensuring consistency and regulatory compliance.
• Performance Management: Monitored and enhanced staff performance, developed strategies to optimize team delivery, and ensured financial success. Conducted thorough investigations to determine policy coverage and.
• Strategic Planning and Reporting: Developed and set targets for associates based on capability assessments, prepared SOPs and SLAs, and maintained CTQ/CTP targets. Generated MIS reports and other statements to provide.
• Vendor Onboarding and Management: Onboarded and managed relationships with various vendors including investigators, hospitals for wellness and cashless facilities, and travel assistance partners. Established and.

Bengaluru, Karnataka, India

• Team Leadership: Managed a Health and P&C Operations team of 60+ for the Singapore region and oversaw a team of 70+ doctors and paramedics for Gulf region health insurance, covering Commercial lines, Motor, Marine.
• Revenue Cycle Management: Directed revenue cycle operations, seeking new billing opportunities to boost revenue and implementing cost-minimization strategies. Led migrations and process transitions to enhance financial.
• Business Continuity Planning: Designed and executed business continuity plans to ensure operational resilience and minimize disruption during process changes and migrations, maintaining critical functions and.
• Internal QMS & ISO Auditing: Conducted internal QMS and ISO audits to ensure compliance with quality management standards and regulatory requirements. Identified areas for improvement and implemented corrective actions.
• Cross-Functional Collaboration: Worked with cross-functional teams and client representatives to analyze requirements, adapt processes, and manage migrations. Successfully led multiple project migrations in the Health.
• Process Improvement: Developed strategic frameworks and plans for associates based on capability assessments. Set targets, established SOPs and SLAs, and maintained Critical to Quality / Critical to Process metrics..

Bengaluru, Karnataka, India

• Managed Health and Commercial lines policies, addressing queries and escalations while consistently meeting KPIs, including Average Handling Time, Quality Metrics, and Compliance Audits.
• Led a team of 20 FTEs in Singapore, overseeing claim payment processing, dispatch, and compiling detailed claims reports.
• Reviewed insurance applications and documents for accuracy, assessed claim validity, and gathered necessary information from policyholders, healthcare providers, and other relevant parties.
• Conducted quality audits to ensure adherence to standards and drive continuous process improvements.
• Enhanced service delivery for Health and P&C teams by brainstorming, providing effective training, implementing quality methodologies, and eliminating non-value-added steps in the process.
• Implemented process optimizations that reduced FTEs by 2 in 2018 and achieved a reduction of 2.5 FTEs in 2019 through idea generation and automation.

Bengaluru, Karnataka, India

• 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.

Msc Nursing, Public Health/ Community Health

Activities and Societies: NSS

B.Sc Nursing, Registered Nursing/Registered Nurse