Summary
Overview
Work History
Education
Skills
Certification
Languages
Hobbies and Interests
Timeline
Generic
AJAY KUMAR

AJAY KUMAR

Bangalore

Summary

As a highly passionate and motivated Health Insurance Business Analyst, I thrive on seeking new challenges and continuously expanding my knowledge in the health insurance industry. My initial years of experience in this field have fueled my desire to delve deeper into its intricacies and innovations. I am eager to join a team of seasoned and experienced professionals, where I can contribute my skills and insights while also learning from the best in the industry.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Sr CLINICAL COORDINATOR

Xlhealth care pvt ltd
Bangalore
12.2015 - Current
  • Collect, analyze, and interpret data related to health insurance claims, patient demographics, and provider performance.
  • Identify inefficiencies in current workflows and suggest improvements.
  • Develop and implement process improvement initiatives to enhance operational efficiency and customer satisfaction.
  • Communicate effectively with internal stakeholders, including management, IT teams, and healthcare providers.
  • Analyze competitor offerings and provide insights for strategic planning.

SENIOR CUSTOMER SUPPORT ASSOCIATE

Accenture Pvt Ltd
Bangalore
05.2012 - 12.2014
  • Interaction with Sales representatives via calls and emails and providing support to them in placing orders for Virgin Media customers UK.
  • Handling process-specific escalations and resolving them on a situational basis.
  • Perform exhaustive data analysis and reporting to derive necessary outputs.
  • Ensuring 100% compliance with all policies and procedures.
  • Responsible for key metrics within the process.
  • Constantly worked with clients during official visits, suggested and successfully implemented ideas for process improvement.
  • Team supervision, performance management.
  • Work Allocation: Allocating work / shifts to team members in order to achieve production targets.

Omega Health Care Pvt Ltd

AR CALLER
Bangalore
03.2010 - 05.2012
  • Call Payer (Insurance) to resolve claims (denial/non-denial) after review from PMS, internal system & process toward resolution (Payment, Adjustment & self-pay).
  • Identify potential process improvements, trends, and issues and escalate them to the supervisor by phone.
  • Follow the workflow documentation, such as the SOP Update tracker, Issue Log, and Trend logs.
  • Resolve complex patient account issues requiring investigation of system timeline comments, payer reimbursements and account.
  • Identify the accounts which does not require calling and can be fixed by Analyst to resolve
  • Logical thinking to identify the trends, resolve accounts for an error free account

Education

Bachelor of Business Administration: BBA -

Arunachal University of Studies
01.2023

Commerce -

RBANM's PU College
01.2006

St Aloysius High School
01.2003

Skills

Data Analysis and Interpretation (SQL, Excel,SAS,R )

Business Intelligence Tools : Experience with BI tools such as Power BI, or QlikView )

Health IT Systems : Familiarity with Healthcare IT Systems, Electronic Health Records (EHR) Health Information Systems (HIS) Regulatory Knowledge HIPAA-related industry standards)

Regulatory knowledge: Understanding healthcare regulations, compliance requirements and HIPPA related industry standards

Certification

  • SQL
  • Python
  • Tableau
  • Power BI
  • BA Centric

Languages

  • English
  • Kannada
  • Hindi
  • Tamil
  • Malayalam

Hobbies and Interests

  • Passionate about maintaining a healthy and active lifestyle through regular exercise, including weightlifting, running, and yoga
  • Traveling: Avid traveler with a love for exploring new cultures and environments.

Timeline

Sr CLINICAL COORDINATOR

Xlhealth care pvt ltd
12.2015 - Current

SENIOR CUSTOMER SUPPORT ASSOCIATE

Accenture Pvt Ltd
05.2012 - 12.2014

Omega Health Care Pvt Ltd

AR CALLER
03.2010 - 05.2012

Bachelor of Business Administration: BBA -

Arunachal University of Studies

Commerce -

RBANM's PU College

St Aloysius High School

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