Dr. Mainak Saha
Bengaluru,KA
Summary
Experienced in analyzing claims and validating data at Carelon Global Solutions LLP. Skilled in fostering teamwork and collaboration. Demonstrated ability to guide teams and improve processes, ensuring compliance and efficient case resolution.
Overview
4
4
years of professional experience
7
7
years of post-secondary education
Work History
Associate Claims
Carelon Global Solutions LLP
05.2023 - Current
- Developed expertise in specific coverage (OA, Data Validation, P2P JJ/KK, Failed Intakes) serving as a valuable resource for colleagues handling similar claims types.
- Collaborated with cross-functional teams, multiple vendors (Pharmaceuticals- CVS, Optum, ESI. TrueRX, RHX, etc.) to resolve complicated cases efficiently.
- Evaluated original investigation reports and verified the data(data validation) of multiple states of USA.
- Ensured compliance with state regulations and actively participated in multiple LOB under US Healthcare & adapting processes accordingly.
- Supported team productivity, assisting colleagues in managing complex claims when needed.
- Guided a team of 3 for understanding the workflow, data validation & guiding for adjustment of claims.
Dental Assistant
Muskan Dental Clinic, Howrah
10.2020 - 04.2021
- Collaborated with dental team members to ensure seamless patient experiences and consistent quality care.
- Performed comprehensive oral evaluations, diagnosing dental conditions and recommending appropriate treatments.
- Developed strong rapport with patients by actively listening to concerns and addressing their questions regarding their oral health status or recommended treatments.
- Educated patients on dental hygiene, pre-surgical instructions and post-surgical care.
Education
MBA - General Dentistry
Institute of Health Management Research (IIHMR-B)
Bengaluru, India07.2023
Bachelor of Dental Surgery (BDS) - General Dentistry
Hazaribag College of Dental Sciences & Hospital
Hazaribagh, India 11.2011 - 07.2018
Skills
Claims analysis
Overapplied Inventory
Data Validation
Claim Adjustment Segment
Healthcare Services & Accumulators
Decision-making skills
Teamwork and Collaboration
Microsoft Office
Languages
Bengali
Bilingual or Proficient (C2)
English
Advanced (C1)
Hindi
Bilingual or Proficient (C2)
Timeline
Associate Claims
Carelon Global Solutions LLP
05.2023 - Current
Dental Assistant
Muskan Dental Clinic, Howrah
10.2020 - 04.2021
Bachelor of Dental Surgery (BDS) - General Dentistry
Hazaribag College of Dental Sciences & Hospital
11.2011 - 07.2018
MBA - General Dentistry
Institute of Health Management Research (IIHMR-B)
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