Diligent, forward-thinking professional with 16+ years of experience, including 10+ years of experience in Healthcare insurance industry. Versatile leader with Six sigma certification who thrives in dynamic, challenging and fast-paced professional environments. Adept at coordinating and managing multiple projects simultaneously. Currently pursuing PMP.
- Multi-unit operations management
- Project Management
- Process transition & Stabilization
- Six Sigma Black Belt Certification
- Sound knowledge in Medicare, Medicaid, Commercial healthcare plans
- Problem solving & Analytical skills
- Team building & Client relationships
- Good in EDI code set & Optum 837 P/I Compliance check
- User Acceptance testing
- Ms Excel, Powerpoint, Word, Visio, Outlook
- Claims Management & Provider Data management
PROJECT MANAGEMENT
• Successfully completed assessment and transition of five complex processes within the defined timeline. Managed Service deliverable, Resource planning & hiring, Resource utilization & IT functionality
• Efficiently led User acceptance testing, transition of Quality audit platform & improve auto-adjudication projects for Facets Transformation.
• Efficiently initiated, master-minded and implemented automation of Non-Participating provider creation, Rejection letter creation, auto-capturing of Coordination of Benefits during data entry.
• Led various Organizational Six Sigma initiatives to improve Customer focused cost reduction project, improve profit margin & improve consistent delivery at par SLA for the account.
• Efficiently gathered requirements, executed, monitored and implemented transformation of Data entry to in-house OCR process.
OPERATIONS MANAGEMENT
• Consistently maintained account profit margin above 40%-45% focusing on Resource utilization, Identifying and removal of waste processes and accelerating productivity through Robotic automation.
TRAINING & MENTORING
• On-the-demand trainer for several batches for cross-training and new-bies on Claims adjudication
• Consistently generated 85 % average scoring classes of Undergraduates and Post-graduates on complex subjects in the field of Bio-Chemistry
Eden Prairie, MN, 01/2013 - Current
- Manage team of claims processors for a Healthcare Payor Operations for processes like Data Entry, Provider Data Management & Configuration. Responsible for hiring, firing and performance management of the team.
- Act as internal department liaison to assist in transition action items (Service
deliverable, Resource hiring, Resource utilization & IT functionality) - Identify and carry out necessary initiatives to meet account deliverable, improve customer experience and retain staff
- Accountable for overall Account Performance
Bangalore, IN, 09/2010 - 12/2012
- Stellar role in delivering substantial revenue, improving productivity, and generating quality improvements through well-managed and on-time projects and support.
- Maintained the quality control/satisfaction records, constantly seeking new ways to improve customer service.
- Effective utilization of techniques like DMAIC, Stratification, SIPOC, Fish bone, FMEA & Cost-Effect matrix for successful completion of project
Houston, TX, 05/2006 - 08/2010
- Identified the potential areas of improvements in various projects and establishing procedures, technological innovations, validations and automation thereby positively impacting on their cost, manpower and/or quality.
- Ensured process adherence through system edits and automation including software testing on regular intervals to reduce variances and control the process.
City, STATE, 10/2001 - 04/2006
- Nationally eligible Professor accredited through ASRB (Agricultural Scientists
Recruitment Board, India) evaluation in Biochemistry for Post Graduate students
By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy
Disclaimer
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
How this resume score
could be improved?
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
resume Strength
- Length
- Personalization
- Target Job
Resume Overview
School Attended
- Sikkim Manipal University
- University of Madras
Job Titles Held:
- Deputy General Manager
- Claims Operations Manager
- Deputy Manager
- Lecturer
Degrees
- MBA
- Master of Science
- Certificate
- Certificate
By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy
