Tableau
Apurva Agarwal
Lead Consultant
Gurugram
Summary
Healthcare IT professional with an enterprise wide experience of almost 9 years in Healthcare insurance industry software development and project implementation and consulting. Primary responsibilities includes Benefits coding, Implementation and Business Solution, Predictive modelling, fraud detection, price optimization,outlier analysis and other business analysis & operational activities for US healthcare client. Focus on the result, drawing key insights and liaise with the team to gain different perspectives. Skilled in creating best in class analytical solutions to deliver significant business impact.
Overview
9
9
years of professional experience
4
4
years of post-secondary education
4
4
Certifications
4
4
Languages
Work History
Lead Consultant
IBM India Pvt. Ltd.
Gurugram
11.2021 - Current
- Proficient in US Healthcare services,HIPAA,healthcare consulting and business analysis.
- Building Predictive Machine learning models for price optimization, Fraud detection, claims severity,outlier claims,CLV(Client Lifetime Value) which will result in cost saving, improving quality of service, client satisfaction.
- Building Clustering models for Claims segmentation,customer segmentation and triage analytics.
- Developing and maintaining 12+ Tableau dashboards used by strategy team to make decision in improving Plan performance.
Consultant
IBM India PVT. LTD.
Gurugram
11.2019 - 09.2021
- Need to collect data from CLAIMS Team in every Regression Cycle. Analyze data and provide detail dashboard for claims billed on basis of different parameters like location,age, type(I/P,O/P,home etc),providers,groups etc and see if there are any irregularities with claims.
- Supported clients with business analysis, documentation, and data modeling as client wants to find variable that mainly affects hospital costs like Age, Gender, Groups,Service type, number of visits to hospital that has maximum expenditures and then to make decisions on providing health plan benefits on renewals. Also analyze factors contributing to payers money.
Benefit Analyst/ Application developer
IBM India Pvt. Ltd
Bangalore
07.2017 - 11.2019
- Customizing and designing application functions as per clinical workflows required by client. Analyze and translate business requirements to technical solutions. Also deliver claims system solutions like Claims, Benefits, Unit/ System/ Integration/ Regression testing.
- Analyzed and evaluated existing benefits programs and recommended improvements on basis of claims billed on different health services based on that take decisions in renewal of health plan benefit’s as well as coding benefits.
- Writing complex SQL queries to extract data as per requirements, perform data preparation and data munging.
Application Developer
IBM India
Bangalore
09.2014 - 06.2017
- Primary job responsibilities includes coding insurance benefits like copay, deductible, coinsurance, federal mandates for US Healthcare client. Responsibilities also include giving clients advice, investigating their claims, and ensuring their claims are processed to completion efficiently and fairly.
- Key Projects worked are ICD-9 to ICD-10 conversion, EHB(Essential Health Benefits), ACA(Affordable care act or Obamacare), Medicare and GNYHA.
Education
Bachelor of Engineering - Chemical Engineering
National Institute of Technology
Rourkela 07.2010 - 05.2014
Skills
Team Management
Certification
Healthcare Management: An Introduction (AHM250)
Software
Jupyter Notebook
Visual Studio Code
SQL Server
MIcrosoft Office
JIRA Software
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
You only have to do a few things right in your life so long as you don’t do too many things wrong.
Warren Buffett
Timeline
Microsoft Azure Fundamentals AZ-900
05-2023
Lead Consultant
IBM India Pvt. Ltd.
11.2021 - Current
Consultant
IBM India PVT. LTD.
11.2019 - 09.2021
Network Management
10-2019
Governance, Legal Issues, Medicare & Medicaid
10-2017
Benefit Analyst/ Application developer
IBM India Pvt. Ltd
07.2017 - 11.2019
Healthcare Management: An Introduction (AHM250)
08-2015
Application Developer
IBM India
09.2014 - 06.2017
Bachelor of Engineering - Chemical Engineering
National Institute of Technology
07.2010 - 05.2014
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