GAURAB SANYAL

Expertise in USA Healthcare Insurance (Payer Side) & Provide side (DDC) - Facets, Facets 594, Claims intake & workflow, Wellpoint group systems, Pega CWS, Medical Billing Processing, Patient Disputes, Medical Billing forwarding, CMS ICD-9, CMS ICD-10, Medicaid, Medicaid reconsideration.

Feedback clearly alongside active listening

Build understanding and trust.

Inspiring the team

Delegating effectively

Focusing on developing others' skills. Driven Team Leader excelling in coordinating teams to achieve strategic goals. Proven ability to foster collaboration, enhance productivity, and streamline processes. Strong focus on developing team members' skills, ensuring high performance and job satisfaction. Deliver impactful results through strategic planning and decisive action.

• Conflict Resolution
• Goal and Deadline Setting
• Commitment
• Being Respectful
• Building Trust
• Demonstrating Stewardship
• Always Communicating
• Being Responsive

• Working for Reputed Health Insurance Company of USA. Managing the Payer Data Management team and responsible for the overall performance. Currently handling a team of 30 associates. Responsible for the TAT, Quality, Client Management.
• Coordinate and manage all aspects of freight shipments, including scheduling, tracking, and documentation.
• Communicate with carriers, vendors, and internal teams to ensure timely and accurate deliveries.
• Analyze freight costs and recommend cost-effective shipping solutions.
• Reviewing medical claims and verifying information for accuracy.
• Processing claims for payment, determining coverage and appropriate coding.
• Examining claims for potential fraud or abuse.
• Resolving discrepancies and other issues.
• Interacting with customers and providers to answer questions and resolve problems.
• Allocates and delegates tasks amongst employees.
• Provides operational support to employees on all phases of transaction processing.
• Interacts with clients and internal departments to solve issues.
• Identifies and resolves issues around pending transactions.
• Performs quality audit on accounts.
• Evaluates internal controls, communications, risk assessments, and maintenance of documentation as related to compliance with internal and external safety, quality, and standards.
• Identifies risk and evaluates deficiencies while working with internal departments and business units to appropriately remedy them.
• Partners with the internal training team to facilitate training on quality assurance requirements, processes, and procedures.
• Expertise in Out-patient, In-Patient claim processing.
• Conduct refresher training for On-floor associates.
• Handling WFO & WFH people for processing claims & sharing updates as per Client requirement.
• Compiling Training Data and MIS and maintain/publish on a daily basis.
• Coordination with Operations.
• Responsible for retro auditing all the claims/Line items/Charts which were worked by the associates.
• Stay in touch with the Client at the Process Owner level on a daily basis to review progress.
• Hold daily conference calls and weekly meetings with Client, Staff and Management to track the progress.

• Best performer as a Processor
• Trailblazer award for BEST QA
• Trailblazer award for BEST SME
• Unsung Hero Award during COVID time for coordinating with Stakeholders