Aniket Shekdar
Pune
Summary
Senior Business Analyst successful at responding to shifting business needs and priorities in a systematic and effective way. Well-versed in the implementation of operational assessments and conducting functional requirements analysis for businesses of all sizes. Quantitative expert in understanding quarterly and annual reports and providing comprehensive syntheses.
Overview
12
12
years of professional experience
Work History
Senior Business Analyst
CitiusTech Healthcare Technology Pvt Ltd
05.2022 - Current
- Confer with clients to identify and document requirements
- Analyze information systems processes, and propose customized solutions to improve performance and efficiency
- Design, Develop, Configure and Test HealthRules Payor configuration, contracts, products, and policies to Implement HealthRules Payor and migrate the current Core Claims Processing system to HRP
- Analyze, configure, test, implement and maintain HealthRules Payor to support changes in contracts, products, legislation, policies, and procedures, ensuring timely maintenance and updates of configuration
- Test, implement, and train on new HealthRules Payor and third-party product releases, modules, and updates
- Provide advice on information systems strategy, policy, management, security and service delivery
- Act as a liaison between the business units, technology teams and support teams
- Conduct tests to ensure the reliability, accuracy, and functionality of system changes and enhancements.
Senior Configuration Analyst
Evolent Health International Pvt Ltd.
12.2017 - 04.2022
- Module Implementation to meet requirements as specified in the project plan
- Carry out the implementation of solutions and designated products following a detailed project plan and in accordance with the contracted project scope
- Identify issues encountered during the implementation of products and when interfacing with systems
- Assist the customer with the configuration necessary to deliver the functionality defined in the contract scope documentation
- Load the initial database delivered to the client with site-specific information (if applicable)
- Present formal training courses and knowledge transfer to client support for all testing phases with the client
- Advise clients on testing strategy and planning to ensure successful solution implementation.
Process Specialist
Infosys BPM
01.2017 - 12.2017
- Assist in the ongoing evaluation of configuration for new and existing claims business rules including member benefits, claims editing, reference data, and system functionality within the claims processing system
- Analyze explanation of coverage documents to assist with determining the best approach for configuring benefits offered including member cost shares, deductibles, and out-of-pocket maximums
- Assist in the setup of code sets and define pre-authorization guidelines used in claims configuration to drive the application of medical policy and accurate claims payment
- Review, analyze and implement database requests from the Best Practice Teams, Medical Directors or other groups responsible for standardization decisions.
Senior Associate
WNS Global Services
01.2012 - 01.2017
- Check applications and forms to be sure they are completed correctly and include the proper supporting documents
- Create and maintain patient and customer records
- Handling the full cycle process of figuring out Why a claim was DENIED and from there researching and figuring out what needs to be done to get it into the appeals process
- Work off 6 proprietary systems, each unique to the client (hospital system) they are working with
- Reviewing claim submissions and verifying the information
- Recording and maintaining insurance policy and claims information in a database system
- Determining policy coverage and calculating claim amounts.
Education
Bachelors in Computer Science - Computer Science
Prof. Ramakrishna More ACS College, Pune
Pune, India04.2010
Skills
- Completed Diploma in Software Testing with First Class
- HealthEdge Certified Business Analyst/Technical Analyst
- Professional, Academy for Health Care Management (PAHM®) certified
Websites
Hobbies and Interests
- Playing Cricket
- Table Tennis
- Badminton
- Travelling to adventurous places
Timeline
Senior Business Analyst
CitiusTech Healthcare Technology Pvt Ltd
05.2022 - Current
Senior Configuration Analyst
Evolent Health International Pvt Ltd.
12.2017 - 04.2022
Process Specialist
Infosys BPM
01.2017 - 12.2017
Senior Associate
WNS Global Services
01.2012 - 01.2017
Bachelors in Computer Science - Computer Science
Prof. Ramakrishna More ACS College, Pune
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