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Dr. R. PRASANNA VENKATESAN, F.I.I.I.,Health Insurance Claims Services Mobile No: + (91) - 98418293474 years in Health Insurance Claims & 16 years Overall Experience Email: [email protected]
AREAS OF EXPERTISE:
Claims Adjudication Claims Analytics MS Office
Claims Query Management Provider Management Regulatory Norms
Claims Negotiation Medical Underwriting Business Acumen
PROFESSIONAL SKILLS ACQUIRED:
Customer Focus Leadership Conceptual Thinking Strategic Planning
Drive for Results Time Management Analytical Thinking Communication
Passion for Excellence Innovator Relationship & Stakeholder
Management
EXPERIENCE ACROSS HEALTH INSURANCE (4 YEARS), HEALTHCARE (8 YEARS) AND PHARMACEUTICAL INDUSTRY (4 YEARS):
1. Star Health and Allied Insurance Co. Ltd, Chennai – 4 years - Asst. General Manager – Claims.
2. Team Formulations – Chennai, India and Shenzhen, China – 4 years – Physician – Product Head
3. Indus Valley Ayurvedic Centre – Mysore, India - 2 Years – Sr. Physician and Marketing Head
4. Le Niol Health Resort, Mahe, Seychelles – 1 year – Physician and Business Manager
ACHIEVEMENTS IN STAR HEALTH INSURANCE (Current Employer):
Due Diligence in Claims Approval / Rejection process and increased customer satisfaction experience.
Claims Data Analysis – Control on Incurred Loss ratio, report to management for every quarter.
Negotiation – Final bill negotiation on high value claim bringing in substantiate quantum reduction of
Rs.2 Lakhs – Rs.3 Lakhs every month in settlement of claims.
Payer Provider Relationship - Exponential increase of the Pan India networking of Service Providers to
7900 hospitals and 1600 Diagnostic Centers in short duration by efficient and prudent mechanism.
Define and Derive Packages – Determine rates for 150+ common Surgical and Medical procedures in
line with geographically reasonable and customary cost for treatments, to facilitate healthy business
model across the chain.
Conduct Health and Wellness programs for individual and corporate customers through our providers.
RESPONSIBILITIES IN HEALTH CLAIM PROCESSING
Subject Matter Expertise - Transform the revenue cycle processes to increase cash flow by minimizing
denials and increasing submission volume and accuracy.
Health / Medical Claims Adjudication as per Regulatory norms through methodical and coherent
approach in claims processing to retain Incurred Loss Ratio.
Provide assistance and expertise in respect of Complex, High Value, Fraudulent and Phantom Claims
and Contested cases.
Monitor medical negligence and violation of clinical, healthcare and statute governance claims.
Review the CQM’s (Claim Query Management) posted by the operation staff.
Effective management of Customer Grievance and Escalation pertaining to claims and provider.
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Dr. R. PRASANNA VENKATESAN, F.I.I.I.,Health Insurance Claims Services Mobile No: + (91) - 98418293474 years in Health Insurance Claims & 16 years Overall Experience Email: [email protected]
Review of hospital tariff against their billing mechanism and prepare optimal utilization reviews to
achieve significant control on claims loss ratio.
Facilitate claim process integration with network providers and their agreed rates for various
procedures.
Provide training to providers on documentation and processes of the company and create a better
understanding and the importance of clean claim submission.
MEMBERSHIP IN PROFESSIONAL BODIES
Member of Tamilnadu Board for Indian Medicine Fellow Member of Insurance Institute of India
EDUCATION
Fellowship Diploma from Insurance Institute of India (FIII), FE-35621, Mumbai. Post Graduate Diploma in Hospital Management from Madurai Kamarajar University. Master of Business Administration (M.B.A) - Marketing at Anna University, Chennai. Bachelor of Ayurvedic Medicine & Surgery (B.A.M.S.), from Tamilnadu Dr. MGR Medical University.
REFERENCESView my public profile at: https://www.linkedin.com/in/drprasanna and connect with me to note on available 360° recommendations on my career milestone.
Other Direct References:
Mr.K.MadanHSE Officer, GASCO,Abudhabi, [email protected]+971 50 2549159
Mr. Sundararaman VSenior Manager, Genpact Services LLC, Dubai, [email protected]+971 55 1724159
PERSONAL PROFILE
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Name : Dr.R Prasanna VenkatesanGender : MaleDate of Birth : January 06, 1977, 39 yearsMarital Status : SingleCurrent Location : Chennai, India.Contact : +91-9841829347Email : [email protected] Number : J4041562
