Six roles that followed the claim from the file to the flood

Mandate

Bring claims, policy servicing, provider networks and grievance redressal under one leadership, and make turnaround and fairness measurable for the board.

Outcomes

• Moved retail health authorisation in-house; median cashless decision fell from 3 hours 10 minutes to 41 minutes and discharge approval from 5 hours 40 minutes to 2 hours 5 minutes.
• Grievances fell from 31 to 14 per 10,000 policies and Insurance Ombudsman awards from 212 to 74 a year between FY2021-22 and FY2025-26.
• Settled 11,900 motor claims after the December 2023 Chennai floods at a median of nine days.
• Suspended 37 hospitals after billing analysis; cluster claims fell from ₹96 Cr to ₹51 Cr a year.
• Cut operations expense per policy by 12 per cent while annual claim volumes grew 46 per cent.

Decisions in context

The managing director asked me to become COO in April 2021, when claims, servicing, hospital and garage networks, grievances and the contact centre reported to four different executives and the board saw each through a different set of figures. My mandate was to put them under one leadership and give the board a small number of measures a policyholder would recognise. Since then we have built an in-house health claims hub in Chennai, moved the grievance team out of claims with authority to revise decisions, written and twice used a catastrophe protocol, and suspended a cluster of hospitals whose billing could not be explained. I lead about 4,100 employees and oversee about 2,300 contract staff through outsourcing partners, with nine direct reports. Underwriting, pricing and actuarial decisions sit with colleagues; my responsibility is that the promises they price are kept on time.

Reason for the move

Current role. Not seeking an executive move; considering one independent directorship with the Nilakhya board's consent.

Mandate

Shorten claim settlement as the company grew quickly, build a fraud control capability and prepare claims operations for catastrophe events.

Outcomes

• Built an in-house fraud investigation unit from nothing to 64 investigators, with analytics scoring every health and motor claim.
• Reduced median motor own-damage settlement from nineteen days to eleven.
• Ran claims after the August 2018 Kerala floods: 6,400 motor and 900 property claims, 88 per cent settled within forty-five days.
• Set up a hospital tariff desk during the 2020 and 2021 pandemic waves to resolve billing disputes before discharge.

Decisions in context

Nilakhya hired me as chief claims officer in July 2016, two years before it listed. Premium was growing by more than a fifth a year and claims had grown with it, but settlement times had lengthened and there was no fraud function of any kind: suspicions went to an outside agency and rarely came back. I built an investigation unit of 64 people and an analytics team that scored every health and motor claim, and moved routine motor assessment to photographs and video so that surveyors could concentrate on difficult claims. The Kerala floods in August 2018 were the first test of the catastrophe protocol I had brought from Chennai. The pandemic waves of 2020 and 2021 were a different test, as hospitals and insurers disputed charges daily, and our tariff desk resolved most disputes before the patient was discharged.

Reason for the move

Promoted to Chief Operating Officer.

Mandate

Bring consistent settlement standards to motor and property claims across seven states in the south and east.

Outcomes

• Settled 82 per cent of 6,900 Cyclone Hudhud claims within forty-five days of the October 2014 landfall.
• Wrote the company's catastrophe claims protocol after the 2015 Chennai floods, when 7,200 motor claims arrived in three weeks.
• Reduced the zone's motor claims pending over ninety days from 14 per cent to 4 per cent.
• Introduced a quarterly review of surveyor reports that removed 23 surveyors from the panel.

Decisions in context

I joined Pratyusha in October 2011 to run motor and property claims for the south and east from Chennai, a zone covering seven states and a panel of 210 surveyors. The first two years were about consistency: the same damage was being settled differently in Hyderabad and Kolkata, and pending claims older than ninety days were 14 per cent of the book. Cyclone Hudhud in October 2014 changed my priorities. It struck Visakhapatnam, the city where I grew up, and produced 6,900 claims in a fortnight. We settled 82 per cent within forty-five days, which the company regarded as good and I did not. The Chennai floods of late 2015 confirmed my view, and I wrote the protocol of pre-agreed surveyor pools, salvage yards and early payments that I have used ever since.

Reason for the move

Offered the role of chief claims officer at a larger insurer preparing to list.

Mandate

Bring order to cashless authorisation as group health volumes and the hospital network grew quickly.

Outcomes

• Cut the median cashless authorisation from about nine hours to 3 hours 20 minutes.
• Built a medical-audit team of 28 doctors reviewing high-value and unusual claims before payment.
• Reduced claims returned to hospitals for missing documents by 40 per cent with a standard checklist agreed with 300 large hospitals.
• Grew the hospital network the company served from 2,100 to 4,300.

Decisions in context

I joined Nirmayam in April 2007 to run claims operations for an administrator that processed group health claims on behalf of five insurers. Volumes were growing faster than the company's processes: cashless authorisations took a median of about nine hours, documents went back and forth with hospitals, and medical decisions depended on whichever doctor happened to be on shift. I built a medical-audit team, agreed a document checklist with 300 large hospitals and organised authorisation by speciality and shift, bringing the median down to just over three hours. The role taught me how hospitals bill and how an administrator is squeezed between insurer, hospital and patient. It also showed me that we were processing decisions that belonged to someone else, which is why I moved to an insurer in 2011.

Reason for the move

Wanted to work inside an insurer, where claims decisions are owned, and to learn motor and property claims.

Mandate

Clear a backlog of old claims and give the region a claims register it could rely on.

Outcomes

• Cleared 2,600 motor and health claims more than six months old within fourteen months.
• Introduced a surveyor allocation register so that every claim had a named surveyor and a due date.
• Reduced average motor settlement in the region from 64 days to 38.

Decisions in context

I moved to the regional office in Bhubaneswar in August 2003 as an assistant manager in claims and became deputy manager in 2005. The region covered Orissa, as Odisha was then called, and I inherited 2,600 motor and health claims more than six months old, many with no clear owner. With a team of fourteen we sorted every file, allocated each to a named officer and surveyor with a due date, and cleared the backlog within fourteen months. The surveyor allocation register we introduced became regional practice. Average motor settlement fell from 64 days to 38. Monsoon flooding in the coastal districts gave me my first experience of claims arriving faster than we could inspect them, though nothing on the scale I met later. By 2007 health insurance was growing fastest, and I wanted to learn it from the administrators who processed most of it.

Reason for the move

Wanted to learn health claims, the fastest-growing line, which the public sector then handled largely through administrators.

Mandate

Assess and settle motor, fire and marine cargo claims for the division.

Outcomes

• Handled about 1,100 claims a year across motor, fire and marine cargo.
• Introduced site visits for every fire claim above ₹5 lakh, which the division later adopted as standard.
• Reduced the division's open marine cargo claims older than a year from 140 to 35.

Decisions in context

I joined Deshbandhu as an administrative officer in August 1999, straight from my MBA, and was posted to the divisional office in Visakhapatnam, the city where I grew up. The division insured port users, warehouses, small manufacturers and a large number of vehicles. With two assistants I handled about 1,100 claims a year, learning to read surveyors' reports critically and to visit the site rather than rely on the file. The fire claim I rejected in 2000, correctly but with a poor explanation, came from this period, and so did my habit of visiting warehouses before deciding. I also worked through a backlog of marine cargo claims at the port, many held up for want of a single document. Promotion to the regional office in Bhubaneswar came in 2003.

Reason for the move

Promoted to assistant manager at the regional office in Bhubaneswar.