I’m a physician turned digital strategist with over 14 years of experience driving healthcare transformation and innovation. My journey has taken me from clinical roles to consulting, where I leverage my healthcare background to optimize processes and implement AI-led automation solutions. I aim to improve patient outcomes and operational efficiencies by translating complex clinical and business challenges into actionable strategies. My passion lies in shaping the future of healthcare through technology and collaboration with key stakeholders.

Dr. Praveen Ganapathiraju

I’m a physician turned digital strategist with over 14 years of experience driving healthcare transformation and innovation. My journey has taken me from clinical roles to consulting, where I leverage my healthcare background to optimize processes and implement AI-led automation solutions. I aim to improve patient outcomes and operational efficiencies by translating complex clinical and business challenges into actionable strategies. My passion lies in shaping the future of healthcare through technology and collaboration with key stakeholders.

Available to hire

I’m a physician turned digital strategist with over 14 years of experience driving healthcare transformation and innovation. My journey has taken me from clinical roles to consulting, where I leverage my healthcare background to optimize processes and implement AI-led automation solutions. I aim to improve patient outcomes and operational efficiencies by translating complex clinical and business challenges into actionable strategies. My passion lies in shaping the future of healthcare through technology and collaboration with key stakeholders.

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Language

English
Advanced
Telugu
Fluent
Hindi
Advanced

Work Experience

Founding Product Manager at NPPD Care (Health & Wellness Startup)
June 1, 2023 - Present
Led product strategy for a first-of-its-kind holistic wellness platform covering 11 wellness domains (Physical, Mental, Emotional, Financial, etc.), driving adoption across B2C and B2B segments. Spearheaded 360-degree wellness program, improving customer retention by 30% through hyper-personalized AI-driven wellness plans. Defined MVP and GTM strategy, leading to a successful beta launch with 1000+ active users in 6 months. Built and scaled partnerships with healthcare providers and corporates, resulting in 25% MoM revenue growth. Designed a data-driven customer engagement model that boosted conversion rates by 40%.
Lead Pega Business Consultant at Maantic Global
June 1, 2023 - Present
Driving digital transformation for healthcare enterprises, focusing on AI-powered automation for claims processing and payer solutions. Optimized claims adjudication workflows, reducing processing time by 35% and increasing auto-adjudication rates by 20%. Implemented AI-driven claims analytics, leading to 15% reduction in fraud detection time. Partnered with stakeholders to design and launch a real-time claims analytics dashboard, improving operational efficiency by 25%.
Principal Business Analyst (Product Owner) at Pega Systems
June 30, 2023 - September 10, 2025
Product lead for Smart Claims Engine, used by major US healthcare payers (Elevance Health, Cigna, Healthfirst). Defined and delivered next-gen AI-powered auto-adjudication features, increasing efficiency by 40%. Led cross-functional teams in building a scalable architecture that processed 500M+ claims annually. Developed and executed a claims fraud detection AI model, reducing fraudulent claims payouts by 30%. Designed end-to-end digital workflows, reducing manual intervention by 50% and improving payer ROI.
Senior Pega Business Analyst at Pega Systems
March 31, 2021 - September 10, 2025
Key contributor to healthcare payer platform innovation. Led the design and implementation of duplicate claims detection and NCCI edits, reducing erroneous payments by 20%. Developed an AI-driven readmission risk model, decreasing hospital readmissions by 15%. Defined interoperability roadmap for FHIR & X12 transactions, enhancing data exchange capabilities.
Principal Business Analyst (Healthcare Industry Applications) at Pega Systems Worldwide India Pvt. Ltd.
April 1, 2021 - June 1, 2023
Directed Smart Claims Engine design and delivery impacting 5M+ claims annually, improving auto-adjudication throughput by 30%. Collaborated with solution architecture teams aligning payer strategy with scalable digital capabilities. Created data-driven scorecards improving operational accuracy by 25%. Advised payer executives on market alignment and regulatory readiness through workshops.
Senior Business Analyst at Pega Systems Worldwide India Pvt. Ltd.
June 1, 2016 - March 1, 2021
Implemented guided event resolution frameworks reducing manual intervention in claims adjudication by 40%. Standardized 25+ reusable healthcare data models with PFHC, driving enterprise data integrity. Served as proxy product owner managing 10+ epics, sprint planning, and release demos. Influenced product roadmap decisions via competitive benchmarking and market research.
Medical Reviewer / Senior Claims Examiner at Global Benefits Group India Pvt. Ltd.
December 1, 2013 - June 1, 2016
Reviewed high-value claims (>$100K), driving 28% error reduction through audit-led process redesign. Developed analytics frameworks identifying leakage patterns and recovery opportunities.
Senior Medical Officer at SAT MED Claim Services
July 1, 2012 - December 1, 2013
Streamlined claims audit operations improving compliance by 99.8% and reducing turnaround times. Created audit dashboards and pre-authorization matrices for fraud detection and cost containment.
Lead Quality Analyst at United Healthcare India Pvt. Ltd. (UHG)
May 1, 2010 - June 1, 2012
Directed quality audits eliminating fraudulent providers through data-driven insights. Enhanced vendor compliance metrics by 40%, improving customer satisfaction.
Medical Officer & Pre-Authorization Head at Heritage Health TPA Pvt. Ltd.
July 1, 2009 - April 1, 2010
Oversaw pre-authorization for 3,000+ monthly claims achieving 98% audit accuracy and TAT compliance. Introduced automation frameworks reducing approval turnaround from 3 days to 1 day.

Education

Medicine at Dr. NTRUHS
December 1, 2002 - December 10, 2008
Postgraduate Program in Product Management (PGPM) at Institute of Product Leadership
January 11, 2030 - September 10, 2025
APGDM (Healthcare Management) at Osmania University
January 11, 2030 - September 10, 2025
IPGD (Life Insurance) at IIRMB
January 11, 2030 - September 10, 2025
BHMS (Bachelor of Homeopathic Medicine & Surgery) at Dr. NTR University
January 11, 2030 - September 10, 2025
BHMS at Bachelor of Homoeopathic Medicine & Surgery
January 11, 2030 - January 21, 2026
MBA at ISBM
January 11, 2030 - January 21, 2026
APGDHHM at Osmania University
January 11, 2030 - January 21, 2026
IPGD (LI) at IIRM (CII London-Affiliated)
January 11, 2030 - January 21, 2026
PGPM at Institute of Product Leadership
January 11, 2030 - January 21, 2026

Qualifications

BHMS
December 11, 2021
PGDHHM
December 10, 2019
CSM
December 11, 2021
PSM
December 11, 2021
PSPO
December 11, 2021
PMI-CDP
December 11, 2021
IIBA-POA
December 11, 2021
PMP
January 11, 2030 - September 10, 2025
CSPO
January 11, 2030 - September 10, 2025
PSM
January 11, 2030 - September 10, 2025
CSM
January 11, 2030 - September 10, 2025
PSPO
January 11, 2030 - September 10, 2025
SAFe PO/PM
January 11, 2030 - September 10, 2025
IIBA-CPOA
January 11, 2030 - September 10, 2025
Pega CSA
January 11, 2030 - September 10, 2025
CPBA
January 11, 2030 - September 10, 2025
CSSA
January 11, 2030 - September 10, 2025
CPDC
January 11, 2030 - September 10, 2025
CPDS
January 11, 2030 - September 10, 2025
SAFe PO/PM
January 11, 2030 - January 21, 2026
PSPO
January 11, 2030 - January 21, 2026
CSM
January 11, 2030 - January 21, 2026
CSPO
January 11, 2030 - January 21, 2026
PSM
January 11, 2030 - January 21, 2026
PMI-CDP
January 11, 2030 - January 21, 2026
IIBA-POA
January 11, 2030 - January 21, 2026
CSA
January 11, 2030 - January 21, 2026
CSSA
January 11, 2030 - January 21, 2026
CPBA
January 11, 2030 - January 21, 2026
MHA
January 11, 2030 - January 21, 2026
PAHM
January 11, 2030 - January 21, 2026
IPGD (LI)
January 11, 2030 - January 21, 2026
Licentiate & Associate (III)
January 11, 2030 - January 21, 2026

Industry Experience

Healthcare, Software & Internet, Professional Services, Life Sciences