Manisha Shinde
Hyderabad
Summary
I am a detail-oriented professional with 4 years of experience in US healthcare operations and technical systems. My background spans claims adjudication, EDI analysis, and complex payroll support, where I've maintained a high standard for accuracy and compliance. I am now an SAP HCM Certified Associate, skilled in using S/4 HANA, Salesforce, and Power BI to streamline data exchange and solve operational puzzles. Having completed my MBA in HR, I am looking for a dynamic role where I can use my technical certifications and cross-functional experience to drive better efficiency and employee outcomes.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Client Success & Operations
Valuelabs
Hyderabad
08.2024 - 01.2025
- Served as the primary point of contact for internal departments and vendors, facilitating communication to gather requirements and provide status updates.
- Analyzed and supported accurate data exchange between business groups, identifying risks and establishing facts to resolve operational issue
- Coordinated the implementation and enrollment process, analyzing and supporting EDI transactions including 834,835 and 833 files, ensuring timely coordination and accurate data exchange between carriers and groups besides Business analyst and data analysts via emails, Salesforce, powerbi and other tools.
- Managed complex implementation and enrollment requests via the Salesforce portal and email, utilizing case management tools to ensure regular follow-up until completion.
- Defining issues, Risks, collecting data, establish facts, and draw valid conclusions to manage daily EDI operations and oversaw error reporting to conduct issue resolution.
- Used Salesforce for case management, stakeholder communication, and project tracking, including dashboards and reporting for internal teams. Besides supporting in Open enrolment process.
- Served as a point of contact between internal departments, vendors, and clients; communicated regularly with business groups to gather requirements and provide updates.
- Collaborated with cross-functional teams using Salesforce and emails to track project tasks, client communications, and implementation progress.
- Interacting with clients to determine and document business requirements.
Claims Adjudicator
Carelon Global Solutions
, India
11.2020 - 02.2024
- Handled end-to-end processing of complex inquiries and appeals, resolving concerns via email and phone with a focus on accuracy and customer satisfaction
- Processed and adjudicated complex healthcare insurance claims and resolving edits in compliance with HIPAA and payer guidelines.
- Experience in IBR reviewing and analyzing facility claims (both inpatient and outpatient) for health plans and third-party administrators (TPAs) to ensure claims are processed accurately and efficiently.
- Conducted thorough reviews of medical records to ensure accuracy and completeness of claims documentation to finalize in accordance with the pricing, Medicare/Medicaid billing, reimbursement, claim payment.
- Resolving edits and errors of the claims to finalize the payments and pricing of the claim.
- Successfully made correct payment after verification of timely submission, eligibility, benefits, deductibles, copay, coinsurance and validation of medical records.
- Played a key role in developing SOP documentation and training materials to improve team quality and audit scores
- Collaborated with cross-functional teams to resolve claim discrepancies and provider escalations.
- Worked on prompt pay claims and high priority claims to clear the high-volume claims under TAT.
- Achieved 98% accuracy rate in claims processing.
- Conducted regular internal audits to ensure adherence to procedural work instructions and identified areas for continuous process improvement
- Improved team audit scores/quality by implementing targeted training based on error trend analysis.
- Monitored team performance metrics and assisted supervisors in continuous process improvement initiatives.
- Played a key role in developing SOP documentation for claims adjudication and adjustments.
- Maintained performance metrics including accuracy, productivity, and customer satisfaction.
HR Intern - Rewards & Recognition
Agnes Softech Pvt. Ltd
Hyderabad
10.2018 - 03.2019
- Supported initiatives to improve employee experience through recognition programs.
- Applied data analysis techniques to gather insights and develop KPIs for measuring impact.
- Designed reports for management to guide decision-making on employee engagement strategies.
Education
MBA - HR
Osmania University
HyderabadB.Sc -
Osmania University
HyderabadSkills
SAP HCM and Salesforce Recruiting and payroll support
- Jira and SharePoint
- Advanced MS Office Suite
- Power BI and Tableau
- SQL proficiency
- Confidential data management
- Stakeholder relations
Certification
SAP Certified Associate - SAP HCM for S/4 HANA, 2024-10-01
Accomplishments
- Achieved 98% accuracy rate in claims processing.
- Improved team audit scores/quality by implementing targeted training based on error trend analysis.
- Monitored team performance metrics and assisted supervisors in continuous process improvement initiatives.
- Played a key role in developing SOP documentation for claims adjudication and adjustments.
- Maintained performance metrics including accuracy, productivity, and customer satisfaction.
Languages
English
Advanced
C1
German
Intermediate
B1
Hindi
Proficient
C2
Timeline
Client Success & Operations
Valuelabs
08.2024 - 01.2025
Claims Adjudicator
Carelon Global Solutions
11.2020 - 02.2024
HR Intern - Rewards & Recognition
Agnes Softech Pvt. Ltd
10.2018 - 03.2019
MBA - HR
Osmania University
B.Sc -
Osmania University