Creating game
D Hemachandran
Customer support
Coimbatore
Summary
Project specialist with over 6 years of experience in the Healthcare Business Process Outsourcing (BPO) sector, specializing in claim adjudication, member enrollment, and pharmaceutical benefits coding. Recognized as a subject matter expert with comprehensive knowledge of provider inquiry processes, enabling thorough verification of benefits and accurate member information. Proficient in enrolling members in application systems to ensure optimal coverage and maintaining drug codes within patient insurance records. Seeking to transition into a leadership role to effectively guide a team in achieving client objectives while upholding a commitment to quality and excellence in the healthcare industry.
Overview
7
7
years of professional experience
2
2
Languages
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.
Education
Bachelor of Science (B.S.) - Software System
03.2018
Skills
Generative AI
Scrum master
Workflow design
Process improvement
Process analysis
Application verification
Report analysis
Presentations
Workflow management
Production deadline management
Continuous improvement
Inventory management
Trend tracking
Schedule coordination
Process mapping
Statement review
Process flows
Year-end processing
SLA accomplishment
Problem-solving abilities
Multitasking Abilities
Time management abilities
Problem-solving
MS office
Adaptability and flexibility
AWARDS
Coral-8., Amber-5., Sapphire-3.
Interests
Learning any new skill
Timeline
Process Specialist - Cognizant Technology Solution
03.2023 - Current
Senior Process Executive - Cognizant Technology Solution
03.2021 - 04.2024
Process Executive - Cognizant Technology Solution
09.2018 - 02.2021
Sri Krishna Arts & Science College - Bachelor of Science (B.S.), Software System