Sachin Tari

In-House TPA Taking Care of Health, Personal Accident and Travel Claims  In-charge for complete Claims and Data management process.  Responsible for productivity levels of all Executives.  Accountable for ensuring adherence to the agreed TAT as per Team KPI.  Identifying suspected fraud agent & clients that helps to cancel the policy mid way.  Continuously exceeding the defined KPI ever since the team was set-up.  Briefly involved with Hospital empanelment activity.  Core committee member for setting-up In-house TPA TPA Monitoring (August 2008-October 2010) Understand Service Level Agreements with TPA and ensure guidelines are met. Monitoring TPA for their activities by regular visit and feed back on reports. In charge and responsible for the TPA payments such as Float management, Recovery process, investigation fees and TPA fees and reviewing Reserve. Keeping a check on claims ratio of every corporate client and sharing the inputs with underwriting and marketing for controlling the same. Preparing a number of different reports that are akin to the management, IRDA, TAC, etc. and had completed such reports in an effective and efficient manner. Authority for providing deviation approval for cases. Successfully implement a cost control method and save 5% of average claim cost. Performed a number of different duties in the claims department. Engaged in tasks such as reviewing insurance claim files, assuring payment was in accordance with company policies and following up on any claims not paid. Dealt with a number of outside parties such as insured individuals, medical health professionals and attorneys

In charge and responsible for the TPA services catered to reputed Health insurance company. In charge of the complete CRM related activities ensuring that the portfolios run smoothly. Handling queries with regards to Claims and Back Office Data Work. Interacting with medical team, claims team and call center to ensure the process run smoothly. Coordinating with outstation offices for cashless claims, Reimbursement claims & general queries. Interacting with the insurance company and their underwriter for the endorsement and for updating data for Insured.

Handling Claims and also queries with regards to Claims and Back Office Data Work Understand Service Level Agreements of clients and ensure guidelines are met. Ensure productivity levels are maintained as assigned of all Executives on the parameters of quality as well as quantity. Interacting with the Quality department to evaluate the performance of every associate.

Handling Claims and also queries with regards to Claims. Understand Service Level Agreements of clients and ensure guidelines are met. Handling escalated claims and makes an adjustment if required. Interacting with the Quality department to evaluate the performance of every associate.