Dr. Ravindra Shingate

I wanted to provide you with an overview of my current responsibilities within the Medical Team, specifically focusing on cashless and reimbursement claims.

1. **Handling Escalations and Grievances:** I effectively manage escalations and grievances from hospitals, customers, and partners, ensuring quick resolutions.

2. **Maintaining SLAs:** I am committed to upholding defined SLA turnaround times (TAT) and continuously strive to reduce the TAT for all claims.

3. **Medical Claims for Travel Insurance:** My role involves dealing with medical claims related to travel insurance, and I ensure the appropriate decisions are communicated promptly regarding these claims.

4. **Litigation Profile:** I attend hearings and handle queries related to the insurance ombudsman and consumer forums. I prepare and share evidence documents while advocating for our contesting points regarding claim rejections and partial settlements.

5. **Data Analysis:** I analyze data effectively to facilitate the best outcomes in my key areas, contributing to overall team performance and customer satisfaction.

• Conducted Denial Audit to prevent further grievances in IRDAI, Ombudsman, and Consumer Forum by rejecting appropriate and legitimate claims
• Resolved customer grievances regarding policy terms and conditions, including deductions and rejections, resulting in increased customer satisfaction
• Focused on customer centricity by ensuring prompt resolution of customer concerns and creating a rejection review team dedicated to delivering the best TAT and customer benefits
• Shared data with management and collaborated with claims, investigation, and network teams to identify areas for improvement
• Achieved top productivity with exceptional quality within the first three months of joining and appreciated with award

• Responsible for analyzing and improving claims processing procedures
• Managed a team of claims adjusters to ensure timely and accurate processing of claims
• Provided guidance and mentorship to team members to improve performance and efficiency
• Demonstrated exceptional conflict resolution skills, resolving numerous customer and HR disputes in a professional and amicable manner in relation with employee's claims
• Consistently ensured customer satisfaction, resulting in a 97% positive customer satisfaction score and a reduction in First Resolution Time (FRT)
• Contributed to the development and implementation of innovative strategies to enhance the customer experience and streamline claims processing

• Spearheaded the establishment of the Audit team for the Health Department
• Analyzed and reviewed Claims, Checked ACS and LR, and acted as a Portfolio Analyst
• Ensured appropriateness and analyzed claims trends to detect fraudulent activities
• Monitored claims deductions in accordance with standard IRDAI NME parameters
• Scrutinized claims approval, identifying duplicate and excess payments/rejections
• Conducted Internal Audits and TPA Claims Audits, Concluded with Recoveries and CAPA
• Represented the organization in Ombudsman Hearings and delivered presentations to management

• Worked in the Authorization department (Cashless Claims adjudication)
• Responsible for decisions on claims i.e
• Approval or rejection Depending on claim conditions
• Assigning claims for investigation to establish Fraud claims
• Team Coordination and Audits of new joiners with training