ESWARAMOORTHI

SENIOR EXECUTIVE

Developed and delivered comprehensive MIS claim utilization reports, driving strategic decision-making and achieving a 15% improvement in resource allocation efficiency through data-driven analysis of key trends and utilization patterns. Generated insightful management reports using MS Excel, facilitating informed decision-making processes and contributing to a 10% reduction in claim processing time. Enhanced data accuracy and reporting reliability by extracting, cleansing, consolidating, and validating data from claim databases, resulting in a 5% decrease in data discrepancies. Designed and implemented interactive dashboards and compelling visual presentations (Pivot Tables, Charts, PPT) in MS Excel to improve data accessibility and communicate key claim utilization metrics to stakeholders effectively. Streamlined the processing of 15-20 daily addition/deletion endorsements in the insurer portal, consistently exceeding service level agreements while maintaining exceptional accuracy. Collaborated with cross-functional teams to gather requirements and deliver customized MIS reports, fostering improved departmental communication and enabling data-driven solutions. Provided data-driven insights on claim utilization trends, empowering management to optimize resource allocation, enhance performance monitoring, and measurably increase operational effectiveness.

• Prepared and analyzed MIS claim utilization reports to track claim processing, trends, and Utilization patterns.
• Generated detailed management reports using MS Excel and other MS Office packages to support decision making.
• Extracted data from claim databases and performed data cleaning, consolidation, and validation for accurate reporting.
• Created Dashboards and visual presentations in MS Excel (Pivot Tables, Charts, PPT) to summarize claim utilization metrices.
• Processing Addition / Deletion endorsements in the insurer portal as per client request (approx. 15-20 request per day.)

Processed and validated group and individual health insurance enrollments through TPA systems, guaranteeing adherence to IRDAI regulations and organizational policies, contributing to accurate and compliant policy administration. Administered member data, enforcing strict compliance standards to ensure seamless policy administration and mitigate potential risks. Collaborated with HR departments and corporate brokers to efficiently process policy endorsements, delivering accurate active member lists and e-cards, enhancing stakeholder communication and satisfaction. Ensured precision in premium calculations, endorsements, and policy issuance, minimizing errors and financial discrepancies, thus contributing to financial accuracy. Maintained meticulous data entry and documentation for new, renewal, and terminated policies, fostering organized and accessible records that streamlined audits and improved data retrieval efficiency. Enhanced member identification processes by digitizing member photos and uploading them to member profiles via the portal, bolstering security and efficiency. Managed the printing and distribution of physical ID cards, coordinating with vendors and validating data via email to guarantee accuracy and timely delivery. Served as the primary point of contact for hospitals, efficiently receiving and registering pre-authorization requests. Validated policy validity, member eligibility, and coverage details, preventing fraudulent claims and ensuring legitimate healthcare access. Scrutinized submitted medical documents for completeness and accuracy, minimizing processing delays and improving the efficiency of pre-authorization reviews. Proactively coordinated with hospitals to obtain necessary documentation, streamlining the pre-authorization process and reducing bottlenecks. Expedited case forwarding to the medical/approval team within defined turnaround times (TAT), contributing to efficient claims processing and timely approvals. Provided timely and accurate communication to hospitals regarding approval status, queries, or denials, ensuring clear and efficient communication throughout the pre-authorization process.

• Process and verify group & individual health insurance enrollments via TPA systems.
• Ensure compliance with IRDAI and organizational policies while managing member data.
• Collaborate with HR and corporate Broker for policy endorsement (Addition & Deletion) and share the active list & e-cards with the stakeholders.
• Ensured accuracy in premium calculations, endorsements and policy issuance.
• Managed data entry and documentation for new, renewal, and terminated policies.