Bismita Nayak

Developed and maintained EDI maps, translation rules, and workflows to support electronic data exchange for enrollment and benefits transactions.

Managed daily EDI transaction monitoring, proactively identifying and resolving discrepancies or errors to ensure 99%+ data accuracy and on-time file delivery.

Collaborated with cross-functional teams (IT, Billing, Enrollment, Client Operations) and external trading partners to gather requirements and implement EDI integrations in compliance with HIPAA and ANSI X12 standards.

Coordinated partner onboarding and EDI testing, ensuring smooth implementation and seamless data exchange between internal systems and clients.

Created and maintained comprehensive EDI documentation, including mapping specifications, SOPs, and partner setup profiles, improving process transparency and audit readiness.

Partnered with IT and developers to automate manual EDI workflows, reducing processing time and improving system efficiency.

Conducted data audits and quality checks to maintain compliance with data integrity, security, and confidentiality requirements.

Supported system upgrades, enhancements, and migrations, ensuring minimal downtime and adherence to project timelines.

Provided training and process documentation for internal teams, improving EDI issue resolution and operational understanding.

Recommended and implemented process improvements aligned with emerging EDI technologies and healthcare data exchange regulations.

• Build relationships with the client team to quickly understand requirements and business objectives.
• Mentored and coached internal and client teams to achieve project targets.
• Oversee the planning, execution and delivery of EDI projects ensuring they are completed on time.
• Collaborate with stakeholders to gather and document requirements and business needs.
• Coordinated and managed weekly project update reports, ensuring clear communication of project status, milestones, and issues to clients.
• Managing and organizing a high volume of email correspondence, ensuring timely and effective communication with internal teams, clients, brokers.
• Scheduling and coordinating client calls, ensuring alignment of availability and efficient use of time for all participants.

• Ensure integrity of enrolment eligibility process.
• Abided by HIPAA requirements and standards by ensuring and protecting consumer’s confidential, identifiable and professional information to third parties.
• Researched and resolved discrepancies in enrolment activities.
• Develop innovative solutions to complex enrolment problems and provide recommendations in regards to new initiatives.
• Maintaining quality parameters with 100% accuracy.
• Thoroughly documenting enquiry outcomes for accurate tracking and analysis.
• Discrepancies found are reported to client everyday via email.
• Verifying enrolment status, making changes to records, researching and resolving enrolment system rejections.
• Addressing a variety of enrolment questions and/or concerns received over phone or email.
• Responding to enquiries concerning enrolment processes.
• Sharing process improvement ideas with Team Leader for smooth running process.

• Worked at Cognizant Technology Solutions for client Carelon Global Solutions India LLP from August 2018 to January 2019 and then re-batched to Carelon Global Solutions India LLP under their payroll from January 2019 to 20 April 2023.
• Ensure integrity of enrolment eligibility process.
• Abided by HIPAA requirements and standards by ensuring and protecting consumer’s confidential, identifiable and professional information to third parties.
• Researched and resolved discrepancies in enrolment activities.
• Develop innovative solutions to complex enrolment problems and provide recommendations in regards to new initiatives.
• Maintaining quality parameters with 100% accuracy.
• Thoroughly documenting enquiry outcomes for accurate tracking and analysis.
• Discrepancies found are reported to client everyday via email.
• Verifying enrolment status, making changes to records, researching and resolving enrolment system rejections.
• Addressing a variety of enrolment questions and/or concerns received over phone or email.
• Responding to enquiries concerning enrolment processes.
• Sharing process improvement ideas with Team Leader for smooth running process.