Dheeraj Tanwar
Delhi
Summary
Strategic healthcare operations specialist with a focus on claims adjudication and denial management. Implements robust processes for policy renewal and system updates, ensuring alignment with client requirements and regulatory compliance. Champions team development and operational training to optimise performance and service quality.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Process Associate
Sunlife Global Solutions Pvt. Ltd.
06.2024 - Current
- Managed Canadian group benefits operations, overseeing policy setup and revisions to ensure compliance and accuracy
- Collaborated with Canadian Service Representatives to gather precise requirements, enhancing operational efficiency
- Prepared management information system (MIS) reports and conducted quality checks for accuracy.
- Coordinated with members and documentation teams to ensure a smooth setup process.
- Participated in weekly calls with partners and clients to discuss progress and updates.
- Facilitated training sessions for new associates on best practices and operational protocols, improving onboarding process
- Facilitated training sessions for new associates on best practices and operational protocols.
- Tools: CHESS, OASIS, Salesforce, JIRA
Senior Process Associate
Sand Martin Consultants Pvt. Ltd.
06.2021 - 05.2024
- Managed U.S. healthcare operations, focusing on claims adjudication and enrolment accuracy
- Reviewed client documents for policy renewal and new setup, ensuring compliance and completeness
- Prepared MIS, MBR reports and conducted quality checks
- Coordinated team performance and optimised workload distribution to meet deadlines
- Handled client communication, escalations, and MOMs
Claims Adjudicator
Digitangle Consultants Pvt. Ltd.
09.2018 - 06.2021
- Processed hospital and provider claims using CPT/ICD codes, ensuring accurate adjudication and timely payments
- Ensured compliance with payer guidelines and SLAs, minimising errors and maintaining quality standards
- Managed denial resolution through CRM, facilitating effective communication with providers to expedite claim approvals
Process Associate
Sand Martin Consultants Pvt. Ltd.
05.2016 - 08.2018
- Processed claims and executed backend healthcare operations to ensure timely resolution
- Ensured accuracy and upheld quality benchmarks in all documentation and reporting
- Collaborated with team members to achieve target results.
- Managed complaints with calm, clear communication and problem-solving.
- Maintained clean, safe working environments to eliminate accident risks.
Executive
NIIT Technologies
02.2015 - 03.2016
- Managed life insurance and annuity transactions to ensure timely and accurate processing
- Coordinated backend processing for policy administration, streamlining workflow and enhancing service delivery
- Delivered high level of service to customers in effort to build upon future relationships.
- Kept organisation in compliance with regulations and internal requirements.
- Formed and sustained strategic relationships with clients.
Education
Bachelor of Business Administration (BBA) -
Hindu Institute of Management
Sonepat01-2014
Skills
- Claims Adjudication
- Denial Management
- CPT/ICD Coding
- Medicare
- Medicaid
- HMO
- PPO
- COB
- EOB
- COBRA
- Revenue cycle management
- US & Canada Healthcare Operations
- Healthcare compliance
- Policy compliance
- MIS Reporting
- Project management
- Document management
- Quality assurance
- Policy writing
- Compliance adherence
- Team management
- Team Handling
- Customer relationship management
Languages
Hindi
English
Awards
- Best Trainee Award - Digitangle Consultants Pvt. Ltd.
- Shining Star Award - Sand Martin Consultants Pvt. Ltd.
Hobbies and Interests
- Cricket
- Volleyball
Certification
- Tally 9.0
Timeline
Senior Process Associate
Sunlife Global Solutions Pvt. Ltd.
06.2024 - Current
Senior Process Associate
Sand Martin Consultants Pvt. Ltd.
06.2021 - 05.2024
Claims Adjudicator
Digitangle Consultants Pvt. Ltd.
09.2018 - 06.2021
Process Associate
Sand Martin Consultants Pvt. Ltd.
05.2016 - 08.2018
Executive
NIIT Technologies
02.2015 - 03.2016
Bachelor of Business Administration (BBA) -
Hindu Institute of Management