ASHWINI P
SENIOR PROVIDER DATA SPECIALIST
Bangalore
Summary
Results-driven Subject Matter Expert with over 7 years of experience in US healthcare, specializing in claims adjudication, provider data management, auditing, and process optimization. Proven leadership in training initiatives, cross-functional collaboration, operational excellence, and quality metric enhancement. Recognized for developing analytical tools using Six Sigma techniques to increase team productivity and error resolution. Committed to fostering a collaborative and growth-oriented work environment that promotes success.
Overview
8
8
years of professional experience
2
2
Languages
Work History
Subject Matter Expert (SME)
UnitedHealth Group / Optum – Bangalore
02.2025 - Current
- Led day-to-day support for provider data operations across multiple teams, serving as the first point of contact for process clarifications, escalations, and audit responses.
- Designed and delivered comprehensive training programs for new hires and cross-functional team members, improving onboarding time and process accuracy.
- Conducted detailed error trend analysis using Pareto charts and 5-Why methodology to identify root causes and reduce recurring issues.
- Improved team-wide quality score from 96.17% to 99% by introducing SOP refinements and reinforcing process controls
- Collaborated with onshore stakeholders to standardize and implement training modules for the entire department.
- Supported SLA compliance across high-volume claims and provider data transactions while maintaining 100% HIPAA adherence.
Provider Data Specialist
UnitedHealth Group / Optum – Bangalore
08.2017 - 01.2025
- Served as a Provider Data Specialist, supporting end-to-end provider operations and ensuring accurate claims payment processes.
- Currently contributing to Optum's high-impact project – VACCN, focusing on provider data management and claims accuracy.
- As a Claims Analyst, consistently ensured member and provider satisfaction by facilitating timely and accurate claims processing with a commitment to 100% quality standards.
- Held accountability for maintaining and updating the provider database, ensuring compliance with turnaround time (TAT) and regulatory standards
- Conducted thorough research and verification of provider records to ensure correct payment outcomes for both Participating (Par) and Non-Par providers.
- Acted as a liaison between internal departments, aiding in the resolution of complex provider-related issues and enhancing operational workflows.
- Maintained accurate and up-to-date provider demographic data across all plan directories and claims systems.
- Ensured precise data entry and updates for both in-network and out-of-network providers within enterprise provider systems.
- Accountable for inputting and maintaining provider contracts and fee schedules, supporting accurate reimbursement for both networked and non-networked providers.
- Played a key role in quality assurance and audit readiness, ensuring all provider data met internal compliance and HIPAA standards, minimizing data discrepancies and rework.
- Accurately updated in-network and out-of-network provider data within Facets, NDB, CLM, and SharePoint systems, enabling seamless access across multiple operational teams.
- Maintained and managed contract loading and fee schedule configuration for varied provider types, directly impacting claims calculation and payment integrity.
- Supported claims release activities by verifying provider information against contract terms, preventing incorrect denials or overpayments.
- Recognized for accuracy, consistency, and process knowledge, contributing to reduction in rework and provider escalations.
Education
B.Com -
NMKRV College For Women
Bengaluru, India 04.2001 -
Skills
Claims Tools: Facets, Macess, NDB, Doc360, Rally, Onbas
Productivity: Microsoft Excel, SharePoint, Macros
Accomplishments
- Topaz/Diamond Awards – Employee Excellence (Optum)
- Best Quality Performer – 6 consecutive month
Timeline
Subject Matter Expert (SME)
UnitedHealth Group / Optum – Bangalore
02.2025 - Current
Provider Data Specialist
UnitedHealth Group / Optum – Bangalore
08.2017 - 01.2025
B.Com -
NMKRV College For Women
04.2001 -
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