Arul Doss R
US Healthcare
Puducherry,Pondicherry
Summary
Highly motivated US Healthcare Manager with 12+ years of experience leading and exceeding KPIs. Proven ability to manage teams, optimize processes, and deliver high-quality customer service in a fast-paced environment. Skilled in communication, collaboration, and driving operational excellence. Tireless Service Delivery Manager talented in assessing client needs and developing solutions to promote business opportunities. Established decision-maker with background in mentoring others to accomplish project milestones. Offering exemplary client relationship building prowess.
Overview
12
12
years of professional experience
Work History
Assistant Service Delivery Manager
Datamatics Global Services Limited
07.2021 - 08.2023
- US Healthcare System and US claims /Enrolment & Billing / Life Insurance processing field Expertise encompasses proficiency.
- Role encompasses reporting on essential project performance indicators to business head in proactive manner
- Ensure prompt acknowledgement, resolution, and clear communication, collaborating closely with team members to address these matters
- Managed 25+ Associates & SME cross-functional projects of medium to high complexity.
- Monitored key performance metrics to identify areas for improvement
- Identify and recommend operational and technological tools to improve efficiency
- Collaborate with other departmental heads and project managers to optimize manpower planning and resource allocation, thereby enhancing headcount efficiency and productivity without compromising quality.
- This approach drives targeted learning and development interventions to enhance team competencies
- Additionally, develop incentive schemes and benefits to motivate the achievement of ambitious goals, ensuring transparent communication with all concerned parties
- Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits
- Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness
- Cultivated and strengthened lasting client relationships using strong issue resolution and dynamic communication skills
- Coordinates daily claims operations including; monitoring inventory priorities, adherence to processing guidelines, Claims System workflow queues, and key performance indicators (KPIs) and metrics, compliance of regulatory and quality standards.
- Created comprehensive reports on service delivery metrics, enabling informed decision-making and continuous improvement efforts.
- Developed and implemented effective communication strategies for team members and clients, fostering collaboration and transparency.
- Coordinated training programs for new hires, accelerating their integration into team and improving overall productivity.
- Conducted regular performance reviews for employees to identify areas of improvement.
- Implemented scalable systems to support business growth while maintaining high levels of service Production & quality.
Senior Quality Analyst (Quality Controller)
NLB Services (NTT Data Global Service)
06.2020 - 07.2021
- Provide front-line supervision for production and quality team of over 10+ team members managing US healthcare payer counterpart claims adjudication, Well care product such as CCP, PDP, Medicaid, Service.
- US Healthcare insurance with insurance payer dealing with claims processing, claims adjudication, claims rework EDI, Paper Claims Provider claims come into Wellcare through three claims channels: DDE, Clearinghouse , Image Net.
- Handling care of entire Quality control with help of an internal and external audit (Head Count 10) team. Process adjudication claims and resolve payments and denials.
- Setup weekly feedback meeting for adjustment team, adjudication team, Provider data management team to share knowledge of high-risk factor errors for week and explain process guide for same errors
- Arranging and chairing weekly team meetings, focusing on Quality targets and achievements, and creating collared periodic reports for client reporting meetings
- Monitored activities and supporting systems to meet compliance regulations
- Check Live audit files and logs to uncover root causes of problems
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration, and teamwork
- Establish and maintain effective work procedures review, assess and identify coaching & training needs to provide staff with necessary skills and knowledge Mentored and coached team members on QA topics and strategies
- Developed reports and materials for key stakeholders related to quality goals, progress and challenges
- Organized and maintained work environment to allow for maximum productivity
- Adhered to standardized project quality assurance best practices, policies and processes
- Improved product quality by implementing rigorous testing protocols and identifying areas for improvement.
- Leveraged strong analytical skills in monitoring performance statistics against established benchmarks, identifying opportunities for targeted improvements in specific areas.
- Streamlined quality assurance processes through development of comprehensive test plans and checklists.
- Developed customized training materials for new hires, promoting rapid onboarding without compromising attention to detail or adherence to quality guidelines.
- Managed Quality Analyst team effectively, setting clear expectations and providing guidance on achieving desired outcomes related to product performance metrics.
- Used MS PPT to create presentations, flowcharts and graphs detailing data analysis results.
- Oversaw opportunities for process optimization using Lean Six Sigma principles (DMAIC process)
Senior Associate (SME) - Claims& Auto Adjudication Special Enrollment
Accenture Global Solutions PVT Limited
12.2011 - 03.2020
- Experience in professional (HCFA), institutional (UB) claims forms Good knowledge of US Healthcare System, Electronic Practice Management (EPM), Document Management (DM), HIPAA Guidelines, EBA, Member Enrollment,NASCO Correspondence.
- Given opportunity to work with Claims Processing Team CS90 System for both Local and National Region Claims of one of Prominent Health insurance Plans in US healthcare.
- Also have been given opportunity to participate in Up-Skill Training for Claims adjudication Invalids Process and get trained on concepts of Home & Host Claims, Maintained good Production, productivity, attendance and 100% quality.
- Processed claims and met process & quality targets.
- Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities
- Handled clarifications, helping team leads and conducted meetings with presentations Side by side analysis with employees.
- Implemented process improvements that led to significant time savings and increased accuracy in deliverables.
- Actively participated in organizational development initiatives like workshops or seminars, contributing valuable insights based on experience.
- Championed best practices in quality assurance, consistently delivering error-free work products that exceeded client expectations.
- Assigned tasks to lower-level personnel based on qualifications and skills set.
- Processed complex claims and assists New Associates Processed high dollar claims Trained Associate.
Education
MBA - System Management
Madras University
Chennai, India06.2013
Bachelor of Science - Management Information Systems
A.M. Jain College
Chennai, India06.2011
HSC - Commerce & Accounting
Government Hr. Sec, School.
Chennai, India03.2007
SSLC -
Santhome Hr.Sec.School
Chennai, India03.2003
Skills
- Claims Processing Software (CS90 Mainframe, CF, CWM, Blue2 , Claims Repository, Claims Admin ,ISG Mainframe WEM ,NASCO Correspondence,WPD,CMA,WGS Mainframe,SAP,Xcelys, etc)
- Operations Support Such as US Healthcare & Life Insurance
- Workload Management & Work distribution
- Regulatory Compliance (HIPAA)
- Quality monitoring ,Good knowledge from Payer and Provider Healthcare
- Good knowledge of HCFA (CMS)1500 and UB 04 claim form & CPT Codes
- Client Relationship Management
- Resource Allocation
- SOP Adherence
- Workload Management
- Operations Support
- Quality monitoring
Personal Information
- Father's Name: RAMACHANDRAN
- Date of Birth: 05/07/1988
- Gender: Male
- Nationality: Indian
- Marital Status: Married
- Passport Number: K5034462
- PAN : AZVPA7261M
Disclaimer
Hereby declares that all the statements above given are true to the best of my knowledge and belief.
Languages
English
Advanced (C1)
Timeline
Assistant Service Delivery Manager
Datamatics Global Services Limited
07.2021 - 08.2023
Senior Quality Analyst (Quality Controller)
NLB Services (NTT Data Global Service)
06.2020 - 07.2021
Senior Associate (SME) - Claims& Auto Adjudication Special Enrollment
Accenture Global Solutions PVT Limited
12.2011 - 03.2020
MBA - System Management
Madras University
Bachelor of Science - Management Information Systems
A.M. Jain College
HSC - Commerce & Accounting
Government Hr. Sec, School.
SSLC -
Santhome Hr.Sec.School
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