K Deepa
Bangalore
Summary
Highly-motivated with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
8
8
years of professional experience
Work History
Process Executive
Intenso Tech Solution
Bangalore
09.2024 - 03.2026
- Verify customer identity, address and beneficial ownership
- Collected and validated customer documentation for compliance
- Assess customer/Business risk profile (low, medium, high) conduct ongoing monitoring
- Apply EDD for high-risk customers
- Monitored transactions for suspicious activity to ensure compliance and mitigate risk
- Collect and analyze customer data for risk assessment
- Ensure AML compliance and regulations
- File SARs and maintain audit trails and records
- Conducted enhanced due diligence checks for PEPs, complex structures, and high-value transactions
- Verify source of wealth and business activities
- Reviewed daily activities for accuracy and operational efficiency, identifying areas for improvement
- Identifying and reporting potential red flags or suspicious activity
- Updating customer records and risk profiles
Provider Data Management
Legato Health Technologies LLP
Bengaluru
09.2020 - 04.2021
- Perform background verification on individuals and entity using appropriate tools (i.e., NPEES, USPS, State license Board, OIG and SAM)
- Assessed claims to determine validity and appropriateness of coverage according to policy guidelines.
- Maintained policies according to Anthem standards.
- Reporting solutions and problems for each and every employee without missing on SLA/TAT times
- Enrolling, updating and disenrolling provider from the system.
- Updating pricing for the provider.
- Developed strategies for resolving complex cases, including those involving multiple parties or high-value claims.
- Performed quality control checks on completed claim files prior to submission for review by management personnel.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Compiled and published hourly count reports to provide insights for team performance evaluation.
- Collaborated with regional teams across the USA to streamline operations and improve service delivery.
Senior Process Consultant
Hinduja Global Solutions
Banglore
04.2018 - 03.2020
- Worked with MEDICARE and CCP ENQUIRY Projects which is internally linked to all major adjudication and re-adjudication processes.
- Processing claims correctly and releasing payment to the provider by using CAS tool within default date.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Researched medical records to evaluate claim validity and verify the existence of pre-existing conditions.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Examined claims, records and procedures to grant approval of coverage.
- Clarified client inquiries via email, providing detailed responses to ensure understanding.
- Managed client escalations, ensuring timely resolution of issues.
- Updated team regularly on process changes, fostering communication and awareness.
- Processed payments for valid claims according to established procedures.
- Created training materials for users on newly implemented processes or system updates.
- Followed up on project progress and ensured timely closure, meeting deadlines.
Education
MBA - Finance And HR
Sri Venkateswara Institute of Technology
Andhra Pradesh, Chittoor03-2017
Skills
- Microsoft Excel
- Microsoft Word
- Claims processing
- Data analysis
Accomplishments
- Received Top Gun awards for exceeding targets.
- Achieved Top Gun awards for meeting SLAs.
- Earned SME (Subject Matter Expert) role within 12 months of experience.
- Mentored new joiners, and played the SME role in the team.
- Maintained data for the team (Production and Quality).
Languages
English, Tamil and Telugu
Timeline
Process Executive
Intenso Tech Solution
09.2024 - 03.2026
Provider Data Management
Legato Health Technologies LLP
09.2020 - 04.2021
Senior Process Consultant
Hinduja Global Solutions
04.2018 - 03.2020
MBA - Finance And HR
Sri Venkateswara Institute of Technology