Dr. Moona Myra Menezes

• Create frameworks/manuals for TPA audits including SOPs, audit schedule, reports and feedback templates
• Identifying gaps in current procedures of TPA operations and propose solutions for the same
• Determine commercial component of the audit by direct savings, recoveries and indirect savings by influencing changes in billing patterns, monitoring utilization, recommendations on tariff negotiations etc

• Oversee complete audit cycles from design/ implementation of the audit and post audit monitoring
• Governance of TPA compliance to local/International regulatory frameworks, market standards, billing rules and internal workflows
• Collaborate closely with business analytics/Actuaries to study claims trends, validate outliers, quantify direct recoveries, indirect savings and monitor billing patterns post audits
• Engage with TPAs directly to present findings, handle rebuttals, negotiations and implement agreed process improvements
• Integral contribution in building and training the current EMEA Network Audit Team at Aetna.

• Assessment of claims across all markets and benefits
• Liaise with vendors for accurate and timely processing of claims
• Dental subject matter expert
• Training claims teams on application of dental benefits and spotting suspicious claims behavior
• Creation of document support for the team for easy reference when dealing with contentious dental claims reducing errors and turn around times.

• Responsible for streamlining direct billing operations like assessment, triage, volumes management and reports
• Periodic analysis of claims data to spot anomalies and identify areas of cost containment
• Design solutions for identified gaps by implementing lean processes.

• Attending to patients‑ all dental procedures and assisting on complex surgeries
• Managing the facility including staff and inventory

Host Live shows on the radio including music selection, audience interactions and managing advertising.

Hosting stage events for popular entertainment events, scientific conventions and award functions.

Managing Sponsorships and patronages for the radio stations

Voice over collaborations with local brands for advert production

• Attending to patients
• Patient/parent counselling and education
• Supervising interns and students during clinical postings
• Organizing community dental camps for children in schools and shelters