Ravikumar M Email & Phone Number

Bengaluru, Ka, In

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 improvements to meet business goals.• 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 compliance and efficiency, and maintain SOPs. Develop a self-learning system for new hires and manage premium payments and insurance queries.• 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 claim-related delays and issues.• Vendor Management: Manage vendor relationships, including TPAs. Conduct performance reviews to ensure service quality and adherence to agreements, and resolve issues to maintain effective partnerships and operational efficiency.

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 implemented process improvements to maximize customer satisfaction.• 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 management with insights into process operations and support critical decision-making.• 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 maintained service level agreements (SLAs) and performance metrics to ensure high-quality service delivery and compliance with organizational standards.

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, Health, and Bancassurance.• 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 performance and efficiency.• 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 adaptability.• 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 to enhance process efficiency and quality.• 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 Care and P&C sectors.• 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. Reviewed insurance claims and policy details for accuracy and compliance.

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.• 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.• Back up for team leader for work allocation, quality analysis, and monthly reports.• Key person in the team for client queries and escalations.

Msc Nursing, Public Health/ Community Health

Activities and Societies: NSS

B.Sc Nursing, Registered Nursing/Registered Nurse