With rising healthcare costs, the entire globe has realized that medical emergencies are unpredictable and can cause severe financial hardship. Furthermore, with growing medical expenditures, access to appropriate medical facilities and hospitalization bills might be financially challenging. As a result, purchasing health insurance for yourself and your family can give the extra safety you require in these trying times.

Raksha Health Insurance TPA, a renowned Third Party Administrator, is dedicated to providing complete client satisfaction. Raksha Health Insurance takes a digital-first approach to health insurance policy servicing and claim administration, providing end-to-end solutions. The organization's persistent customer-first attitude has been the foundation of its ongoing development and progress. We are happy to have spent over two decades developing robust and user-friendly process procedures in order to provide the finest services to all of our stakeholders.

Speaking of this, Dr. Soumya Tyagi Gautam, COO of Raksha Health Insurance TPA, has been instrumental in propelling the company's growth. Dr. Soumya brings extensive experience in Strategic Engagement & Relationship Management by driving transformation through the deployment of automation via AI & ML, developing and implementing continuous improvement methods, and upgrading processes to improve productivity, efficiency, quality, and customer experience. She also has experience creating and executing methods to minimize overall operational risks, as well as building and enforcing internal controls and risk management frameworks.

Share us some important facts about your organization.

We are the pioneers and first in the league to employ technology-based processes, resulting in shorter turnaround times and increased quality and accuracy, with our innovative auto claim adjudication methods using Artificial Intelligence, Robotics, and Machine Learning. Our focus on providing quality services extends well beyond claims management. We intend to simplify and minimize the process's complexity, making it simple and effective for all parties.

Take us through your early educational journey and prior industry experience that you bring to the table. What motivated you to venture into the field of healthcare and gain expertise as a health insurance specialist?

I'm a licensed MD Physician with over 26 years of cumulative experience, 18 of which have been in the Life and Health Insurance Industry. After receiving my MD from the Moscow Medical Stomatological Institute N.A Semashko, I spent nine years in clinical medicine, working as a resident at the AIIMS, N. Delhi, and some of the most prestigious nursing homes in Delhi NCR, Allahabad, and West Bengal. I am a Fellow of the Academy of Life Underwriting and a qualified Six Sigma Green Belt from the esteemed Motorola University, Schaumburg. I accidentally embarked on my Insurance Industry journey while I was on a sabbatical from work to take care of my little daughter. Risk Medicine and Insurance were a novel concept for me when I first ventured into the Health Insurance Industry as the Head of Cashless & Claims at Vipul Medcorp TPA in 2004. What started as an interim experiment led to my lifelong love affair with the Insurance industry. I took to risk medicine like a fish to water, and while it provided me new avenues to explore, at the same time, it also kept me connected with my core occupation as a doctor.

In December 2006, armed with a wealth of knowledge and expertise, I moved to the life insurance industry as the Head of Medical Network at Max New York Life Insurance. Max Life provided me with the perfect landscape to learn and enriched my knowledge on various competencies in the Life Insurance Industry from Provider Network Management to Customer Satisfaction, Underwriting, New Product Launch, Internal & External Stakeholder Management, and Quality & Process Improvement. After a decade of professionally and emotionally gratifying experience with Max Life Insurance, I was ready to take-on new responsibilities and use what I had learned there. I joined Raksha Health Insurance TPA in December 2016 as the National Head of Operations, and in March 2021, I was promoted to Chief Operating Officer.

What are the various roles & responsibilities that you currently shoulder at Raksha Health Insurance? What are some of the most challenging aspects of your role as the Chief Operating Officer? How do you overcome them?

I have been in charge of all operations across all business verticals, leading Internal Stakeholders and Department Heads in Claims Administration, Account Management, Grievances Management, and Customer Servicing. To achieve operational efficiency and effectiveness, I am always working towards optimizing the workflow and processes through automation and continuous improvement approaches. Further, I'm involved in business strategy, risk and compliance, and regulatory and legal issues. I also assist in the conceptualization and implementation of long-term strategies, the development & maintenance of great relationships, the monitoring & ascertainment of improvement in all aspects of process metrics, and the redefinition & restructuring of teams towards CoE (Center of Excellence).

What are some of the most challenging aspects of your role as the Chief Operating Officer? How do you overcome them?

Since the onset of the pandemic, remote working through digital platforms has become the new normal. As employees continue to work from their homes and offices, overcoming the gaps in the hybrid work model has been a new challenge not just for me but for all COOs. Investing in digital workplace solutions, creating flexible work policies, strengthening enterprise connectivity, and sustaining relationships virtually have been the key tools we at Raksha have used to overcome this challenge.

“Through effective and compassionate people management, i have added value to the efforts of every organisation by nurturing young talent and building high performing teams that excel in delivering business value and customer satisfaction.”

While digital platforms have been a boon to keep the businesses up and running during the pandemic times, curbing growing cybersecurity threats has been yet another challenge of recent times. Remote work, presence of multiple stakeholders, and dependency on unsecured networks and VPN connections can put enterprise security at great risk. With professional hackers looking to corrupt the network, steal sensitive data, and cripple businesses, the C-Suite leaders in today's times need to minimize their threat landscape and invest in robust cybersecurity solutions that can preempt & thwart attacks in time. At Raksha we have been extensively working towards improving the maturity level of cybersecurity, conducting frequent risk management audits, and constantly training our workforce to help preempt this risk.

Last but not the least, with the need for instant gratification, one of the greatest challenge for the COOs is meeting and exceeding customer expectations. With customer experience and satisfaction going for a toss these last two years, COOs have a major responsibility at hand ­ to offer customers tailored and personalized experiences along with new and improved ways of engaging and interacting with the brand. At Raksha, while we have leveraged technology to reach out to our customers through various digital platforms such as our Industry first AI driven Whats App chatbot, our upgraded and user friendly mobile app and interactive website, we have maintained our human touch through our dedicated and customer centric relationship teams who practice and personify the concept of `Customer First'.

“My intrinsic drive to help people has led me to make extraordinary efforts in establishing and implementing effective quality management systems that exceed all established targets by assuring customer connections and retention.”

What have been the most significant milestones that you have achieved so far in your professional journey? What has been the driving force behind your successful journey as a business leader?

People have been the motivating reason behind my successful company leadership path. My intrinsic drive to help people has led me to make extraordinary efforts in establishing and implementing effective quality management systems that exceed all established targets by assuring customer connections and retention. Through effective and compassionate people management, I have added value to the efforts of every organisation by nurturing young talent and building high performing teams that excel in delivering business value with high morale, as well as leading, training, and mentoring the teams to maintain excellence in service operations And this has been the most significant milestone of my professional journey.

How do you keep yourself well aligned with the periodic evolutions occurring within your respective field of work?

Considering change is the one constant that leads to progress, I remain ahead of the curve by attending industry conferences, events, and workshops and reading relevant literature. I also make it a point to engage with industry peers and the next generation on a frequent basis in order to stay on top of new advancements and any holes that may need to be filled.

As a successful professional, what would your advice be to young women and girls aspiring to become business leaders and entrepreneurs in the future?

Don't let your gender limit your ambitions. Set clear goals, keep focused, work hard, and offer no excuses. Make time management your number one concern. Never, ever stop learning. Take decisions even if you stumble, since each slide is an opportunity to learn how to get back up and climb again.

Dr. Soumya Tyagi Gautam, COO, Raksha Health Insurance TPA

Offers end-to-end solutions for health insurance policy servicing and claim management.

Educational Qualification: M.D (Physician)

Services provided by firm: Third Party Administrator in the Health Insurance Industry

Headquarter & Other Office Locations: With our headquarter in Faridabad, we have our footprints in 88 locations Pan India with decentralized offices in all Metro and major cities.