Open to opportunities

prathyusha reddy

@prathyushareddy

Message

I lead healthcare benefits, claims, and service delivery operations at scale.

India

Message

What I'm looking for

I'm looking to lead healthcare, benefits, claims, or service-delivery operations where I can improve SLA performance, build frontline leaders, scale cross-functional programmes, and partner with Product and Tech to solve systemic delivery challenges.

I've led healthcare operations across FlipHealth, IKS Health, and MediBuddy, spanning benefits administration, TPA and insurance claims, telehealth, pharmacy, diagnostics, and clinical programmes.

At FlipHealth, I owned end-to-end delivery for a 30+ member cross-functional team, managing claims adjudication, workforce planning, SLA/TAT governance, enterprise stakeholders, vendor operations, and customer support. I sustained 100% SLA/TAT compliance and 95%+ team retention while driving automation and risk-management initiatives.

At IKS Health, I led teams supporting high-volume US physician practices, reduced clinical documentation errors and escalations by 70%, and resolved 90%+ of escalations through quality redesign, coaching, and corrective action planning. I was awarded Best Team Manager twice.

Earlier at MediBuddy, I launched and scaled the Maternity Care Programme and expanded delivery into EAP, chronic care, nutrition counselling, and diabetes wellness. My clinical background in Oral Medicine and Radiology strengthens my judgment around provider workflows, medical documentation, and healthcare compliance.

Experience

Work history, roles, and key accomplishments

Operations Specialist

FlipHealth India Pvt. Ltd.

Jan 2025 - Jun 2026 (1 year 5 months)

Owned end-to-end operations delivery across OPD, TPA/insurance claims, pharmacy, diagnostics, teleconsultations, and wellness for a 30+ member cross-functional team. Managed claims operations, SLA/TAT governance, workforce planning, and cross-functional stakeholder management.

Claims Processing Claims Adjudication TPA Operations SLA TAT Governance Workforce Planning capacity management KPI Dashboards Root Cause Analysis CAPA Vendor Management Customer service management

Team Manager – Healthcare Operations

IKS Health Pvt. Ltd.

Oct 2022 - Nov 2024 (2 years 1 month)

Led a 20-member cross-functional team supporting high-volume, multi-speciality US physician practices. Delivered 100% SLA/TAT compliance, reduced clinical documentation errors by 70%, and drove workforce planning and capacity forecasting.

Team Leadership Coaching SLA TAT Governance Quality Audits Workforce Planning Escalation Management HIPAA compliance Process Improvement KPI Reporting

Consultant

D-Care Dental Clinic

Jan 2022 - Sep 2022 (8 months)

Managed clinical delivery with a focus on quality, compliance, and patient-centred outcomes, overseeing case documentation and treatment-plan follow-through.

Clinical Documentation Patient Care Compliance Quality Assurance

Team Leader – Specialist Healthcare Programmes

MediBuddy

Oct 2017 - Dec 2021 (4 years 2 months)

Owned end-to-end planning, launch, and scale-up of the Maternity Care Programme, coordinating scope, staffing, and delivery across clinical, operations, product, and technology teams. Expanded portfolio into EAP, chronic care management, nutrition counselling, and diabetes wellness.

Program Management Provider Network Management KPI Dashboards Process Standardization Workforce Planning SLA TAT Governance Cross functional Coordination

Dental Surgeon (Part-Time)

D-Care Dental Clinic

Apr 2015 - Dec 2018 (3 years 8 months)

Delivered clinical services with consistent focus on quality standards, documentation accuracy, and patient outcomes, maintaining detailed case records and treatment documentation.

Clinical Dentistry Patient Care Documentation