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Santhosh Kumar Siricilla

@santhoshkumarsiricil

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Insurance claims professional at Aditya Birla Health Insurance who recovered over ₹1 Crore in fraudulent payouts.

Italy

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At Aditya Birla Health Insurance Co. Ltd., I audited complex corporate claims, analyzed loss drivers across 100+ policies, and supported underwriting recommendations. I also investigated irregular hospital billing with FWA teams, contributing to the recovery of over ₹1 Crore in fraudulent payouts.

Before that, I worked as a Duty Medical Officer in the ICU at Russh Super Specialty Hospitals, supporting critical care and coordinating with multidisciplinary teams. I’m pursuing the Master in insurance and risk management at MIB Trieste, with coursework in enterprise risk management, Solvency II, and insurance operating models.

Experience

Work history, roles, and key accomplishments

Insurance Claims Manager

Aditya Birla Health Insurance Co. Ltd.

Sep 2025 - Sep 2026 (1 year)

Audited complex corporate claim dumps, evaluated claims data across 100+ policies, and coordinated FWA investigations to reclaim fraudulent payouts. Oversaw TPA operations and maintained 98% SLA/TAT compliance.

Claims Auditing Claims Adjudication Loss Ratio Tracking TPA Governance Fraud Waste and Abuse Investigation SQL Python Data Analysis Tableau Power BI

Duty Medical Officer - Intensive Care Unit

Russh Super Specialty Hospitals

Jan 2024 - Sep 2025 (1 year 8 months)

Monitored ICU patients' vital signs and hemodynamic parameters, delivered ventilator and oxygen therapy, and assisted with intubation, central venous catheterization, and CPR during emergencies.

ICU Monitoring Ventilation Support Oxygen Therapy Intubation Central Venous Catheterization CPR Critical Care Multidisciplinary Care

Education

Degrees, certifications, and relevant coursework

MIB Trieste School of Management

Master in Insurance and Risk Management (MIRM), Insurance and Risk Management

2026 -

Pursuing a Master in Insurance and Risk Management (MIRM) in collaboration with the University of Trieste, with coursework in enterprise risk management, Solvency II, and insurance operating models.