D Hemachandran

Work History

Process Specialist

Cognizant Technology Solution

03.2023 - Current

Provider written inquiries should encompass and explicitly address any questions or concerns that may arise regarding various provider-related issues. These inquiries should be directed towards resolving matters that can be effectively handled during the initial call or through the first email correspondence. It is important to ensure that any potential questions are clearly outlined and can lead to resolutions within that initial interaction.
Roles & Responsibilities: I possess extensive and comprehensive knowledge of the various processes associated with provider inquiries, which allows me to effectively and accurately verify the benefits associated with each specific service based on the contracted member information available. This expertise enables me to navigate complex situations with ease and ensure that all necessary details are thoroughly checked and confirmed. Additionally, I take on a leadership role within the team, guiding and motivating my colleagues to achieve an impressive 100% quality and production rate, all while adhering to the expected timelines for our deliverables. My commitment to excellence drives the team to consistently meet and exceed our performance goals.

Senior Process Executive

Cognizant Technology Solution

03.2021 - 04.2024

Enrollment codes help categorize participants in membership programs based on their enrollment method or other criteria. For instance, codes can be created for those who enroll online, at their workplace, or as part of a social group. These codes can be linked to guest profiles through the Membership options on the Profile screen. Additionally, enrollment codes can be grouped into enrollment groups. This allows you to configure points calculation rules for members based on their enrollment methods.
Roles & Responsibilities: Enrollment codes help categorize participants in membership programs based on their enrollment method or other criteria. Codes can be created for those who enroll online, at their workplace, or as part of a social group. These codes can be linked to guest profiles through the Membership options on the Profile screen. Additionally, enrollment codes can be grouped into enrollment groups. This allows you to configure points calculation rules for members based on their enrollment methods.

Process Executive

Cognizant Technology Solution

09.2018 - 02.2021

Anthem's pharmacy benefits effectively manage costs while addressing your business needs. You and your employees can easily access these benefits through a single account team, ID card, and mobile app. We leverage integrated, Realtime data and predictive analytics to identify risks, forecast clinical outcomes, and close care gaps. Our plans feature connected specialty drug management across both medical and pharmacy benefits. We prioritize clinical-first medication reviews for drugs that enhance health and reduce overall costs. Additionally, we collaborate with providers to promote prescriptions that yield better clinical outcomes at lower costs.
Responsibilities: I am responsible for a variety of tasks, including the assignment of specific projects to associates within the team. This involves not only distributing these assignments but also ensuring that all relevant intake information is updated promptly in the shared worksheet. Additionally, I am tasked with the critical responsibility of closing JIRA tickets based on requests that come in from our onshore team. Moreover, an essential part of my job involves accurately coding the medication and verifying the corresponding insurance coverage for each patient. This coding process is crucial as it ensures that the necessary information is communicated effectively to our onshore colleagues. On top of that, I perform detailed audits of external insurance coverage as specifically requested by our clients who are based onshore, ensuring that all information aligns with their needs and expectations.
Completed bi-weekly payroll for employees.

Summary

Overview

Work History

Process Specialist

Senior Process Executive

Process Executive

Education

Bachelor of Science (B.S.) - Software System

Skills

AWARDS

Interests

Timeline

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