C Paul
Deputy Manager
Kolkata
Summary
With a proven track record at Sunknowledge Services Inc., I excel in operational excellence and team leadership, enhancing organizational development and performance metrics. My expertise in data analysis and employee motivation led to significant operational improvements, showcasing my ability to drive results and foster a collaborative team environment.
Overview
17
17
years of professional experience
Work History
Deputy Manager of Operations
Sunknowledge Services Inc.
Kolkata
04.2018 - 12.2024
- Managed recruitment processes encompassing job postings and interviews.
- Developed routine reports leading to informed corrective actions and enhancements.
- Utilized excellent conflict resolution abilities to enhance client relationships through active communication.
- Evaluated staff for continuous improvement and goal attainment.
- Worked alongside multifunctional teams to innovate responses to operational hurdles.
- Evaluated performance using key performance indicators and various metrics.
- Managed key milestones to align with scheduled timeframes and allocated resources.
- Managed daily workflow of the Operations department by assigning tasks appropriately.
- Handled and settled critical customer service concerns efficiently.
- Identified areas for process improvement and developed action plans accordingly.
- Delegated work to staff, setting priorities and goals.
- Identified areas of deficiency and performed root-cause analysis to solve problems.
- Monitored employee attendance records to ensure compliance with company policy.
- Built strong operational teams to meet process and production demands.
- Managed scheduling, training and inventory control.
- Enhanced team morale through implementation of employee recognition systems.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
Assistant Manager - QA
Sunknowledge Services Inc.
Kolkata
10.2014 - 03.2018
- Maintained comprehensive documentation of quality assurance procedures.
- Directed complex claims to relevant personnel for further examination.
- Managed billing processes for various medical specialties.
- Guided team members to ensure timely task completion according to specifications.
- Compiled comprehensive reports on project advancements for senior management evaluation.
- Assisted senior auditors in preparing audit documentation and work papers.
- Managed and trained team members to enhance audit department performance and increase operational efficiency.
- Provided support in the follow-up on the implementation of audit recommendations and corrective actions.
- Documented audit procedures and findings in accordance with company and regulatory requirements.
- Cross-trained employees, enabling completion of priority tasks during personnel absences.
- Utilized software tools and audit methodologies to enhance audit efficiency and effectiveness.
- Prepared detailed reports highlighting audit findings and recommendations for improvements.
- Participated in meetings with clients to discuss audit processes and findings.
- Translated complex audit data for management's easy comprehension.
QA Lead
Sunknowledge Services Inc.
Kolkata
04.2014 - 09.2014
- Collaborated with quality team regarding quality assurance reviews.
- Researched customer inquiries, identified root causes of problems, and resolved issues in a timely manner.
- Oversaw onboarding processes for new team members, delivering training on claims handling.
- Led team in investigating, evaluating, and settling insurance claims, ensuring compliance with policy obligations and legal requirements.
- Managed complex claims negotiations, achieving favorable settlements within policy limits.
- Submitted clean claims to reduce denial rates, following payer reimbursement policies and procedures.
- Conducted meetings to discuss issues and find pertinent solutions to problems.
- Performed quality checks on completed claims documents prior to submission for approval.
- Monitored objectives to determine effectiveness of workflows, facilitating training, and mentoring for improvement.
- Trained new team members on policies and procedures for claims handling.
- Collaborated with team members across multiple departments to resolve escalated disputes quickly.
- Developed training materials for staff members on effective methods for resolving complex claims issues.
- Created reports documenting claim history, payment status, dispute resolution outcomes.
- Analyzed claims data to identify patterns, fraud risks, and areas for process improvement.
Quality Analyst
Sunknowledge Services Inc.
Kolkata
03.2011 - 03.2014
- Discussed importance of statutes and strategies for improved adherence with team.
- Facilitated communication between management and team members.
- Evaluated risks highlighting possible compliance issues with client demands.
- Coordinated with medical experts to evaluate the extent of injury claims.
- Supervised independent adjusters to promote adherence to guidelines.
- Reviewed and resolved open claims and change orders to determine entitlement for additional payment.
- Maintained up-to-date knowledge of regulatory changes affecting claims processing.
- Reviewed claims to ensure accuracy, resulting in multiple claim reductions.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Handled billing related activities focused on medical specialties.
- Examined claims investigated by independent adjusters.
- Conducted training sessions for new claims examiners.
- Resolved complex problems relating to claim adjudication processes.
- Provided training to new staff members on quality assurance processes.
- Performed audits of claims systems to identify potential areas of improvement.
Claims Adjuster
Sunknowledge Services Inc.
Kolkata
03.2010 - 02.2011
- Investigated questionable claims to determine payment authorization.
- Used insurance rate standards to calculate premiums, refunds, commissions and adjustments.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Examined claims, records and procedures to grant approval of coverage.
- Maintained accurate documentation relating to all claims processing activities.
- Researched and resolved discrepancies between customer records and insurance policies.
- Processed adjustments, cancellations, renewals, and reinstatements as needed.
- Handled billing related activities focused on medical specialties.
- Organized information by using spreadsheets, databases or word processing applications.
- Determined coverage by examining claim forms and supporting documents.
- Utilized claims processing software to streamline workflow and increase efficiency.
- Researched medical claims for validity to resolve discrepancies.
- Followed up on pending claims and resolved issues delaying processing.
- Maintained confidentiality of policyholder information in compliance with HIPAA regulations.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
Senior Associate
Wipro BPO
Kolkata
03.2008 - 02.2010
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Handled medical claim processing for both outpatient and inpatient services.
- Ensured claims processing adhered to set timeframes and UHG quality standards.
- Handled floor support during SME's absence.
- Processed claims routed out of automatic adjudication within current turnaround standards.
- Interpreted deductible, coinsurance, and copay details for claims.
- Adjusted and claims under close supervision of more experienced claims team members.
- Completed day-to-day duties accurately and efficiently.
- Worked with cross-functional teams to achieve goals.
Education
Bachelor of Arts - Political Science
Radha Govind University
Ranchi, Jharkhand05-2019
Skills
- Operational excellence
- Performance Metrics
- Workforce planning
- Organizational development
- Asset management
- Scheduling management
- Performance monitoring
- Operations management
- Performance reporting
- Production
- Team building/leadership
- Employee motivation
- Microsoft office expertise
- Data analysis
- Team leadership
- KPI tracking
- Staff training
Affiliations
- Cooking or baking
- Community service
- Teaching
Languages
Hindi
First Language
Malayalam
Advanced (C1)
C1
English
Proficient (C2)
C2
Bengali
Elementary (A2)
A2
Timeline
Deputy Manager of Operations
Sunknowledge Services Inc.
04.2018 - 12.2024
Assistant Manager - QA
Sunknowledge Services Inc.
10.2014 - 03.2018
QA Lead
Sunknowledge Services Inc.
04.2014 - 09.2014
Quality Analyst
Sunknowledge Services Inc.
03.2011 - 03.2014
Claims Adjuster
Sunknowledge Services Inc.
03.2010 - 02.2011
Senior Associate
Wipro BPO
03.2008 - 02.2010
Bachelor of Arts - Political Science
Radha Govind University
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