Facets
Milan Pandya
Pune
Summary
Results-driven Enrollment Analyst with expertise in data analysis and EDI processing. Proven track record in resolving discrepancies and managing enrollment processes to enhance operational efficiency.
Overview
19
19
years of professional experience
9
9
Certifications
Work History
Sr Enrollment Analyst
Evolent Health International Pvt Ltd
Pune
10.2020 - 01.2026
- Conducted research on various data sources to identify accurate information for problem analysis.
- Investigated member requests and issues as reported by vendors, clients, and Account Management.
- Tracked and monitored member enrollment processing, identifying issues and implementing solutions.
- Processed EDI enrollment files accurately and efficiently to ensure timely enrollment.
- Verified and reconciled enrollment reports to confirm eligibility for coverage.
- Identified, resolved, and documented reconciliation discrepancies independently while processing refunds and premium transfers.
- Corrected issues with electronic transfer systems (EDI files) in collaboration with carriers.
- Served as a subject matter expert on eligibility guidelines and EDI protocols for clients.
Jr Commercial Officer
Chordia Food Products Ltd
Pune
01.2020 - 08.2020
- Supervised cold storage upkeep to maintain compliance with safety standards.
Administered purchasing processes for a variety of materials needed.
Conducted office banking activities alongside administrative responsibilities for enhanced organizational effectiveness.
Admin Head
Ruchir Foods
Pune
04.2017 - 01.2020
- Oversaw all banking operations and managed account department activities.
- Coordinated production stock management and order fulfillment processes.
- Collaborated with designers on product launch designs to ensure timely execution.
- Directed social media presence and digital marketing efforts across platforms including Amazon and Flipkart.
- Managed daily administrative tasks to promote efficient workflow among departments.
Admin & Billing Head
Shriram Texttiles Mills
Pune
12.2015 - 02.2017
- Managed billing department operations to ensure accuracy and efficiency in daily tasks.
- Collaborated with diverse teams to resolve product and service-related issues.
- Proposed innovative solutions to improve team performance and achieve objectives.
Quality Auditor
Trizetto A Cognizant company
Pune
04.2013 - 10.2015
- Conducted audits following defined specifications and methodologies.
- Documented critical audit findings for comprehensive reporting and analysis.
- Provided timely audit updates to management to facilitate decision-making.
- Delivered daily error feedback to operations team, enhancing performance.
- Updated processors on error trends and identified areas for improvement.
- Facilitated error review sessions to achieve targets and maintain quality standards.
- Monitored transactions daily to ensure compliance with operational guidelines.
- Acted as first escalation point for resolving business queries within the team.
Enrollment Associate
Trizetto A Cognizant company
Pune
09.2010 - 03.2013
- Enrolled subscribers and dependents in Aldera system.
- Updated member plans and coverage details.
- Verified member information from 834 EDI files.
- Processed reinstatements and reenrollments for members.
- Generated end-of-day reports utilizing Excel.
- Created weekly reports for client distribution.
- Protected health information in compliance with regulations.
Claims Associate
Trizetto Services India Pvt Ltd
Pune
08.2006 - 08.2010
- Verified provider and member information against system data for accurate claim processing.
- Conducted service line checks on claim images to ensure compliance with guidelines.
- Determined coverage status for services based on established policies.
- Reviewed other medical coverage and corresponding EOBs to apply coordination of benefits.
- Checked member out-of-pocket expenses to confirm eligibility for claims processing.
- Processed claims according to established guidelines to maintain efficiency and accuracy.
- Communicated updates regarding new claim processes to team members for alignment.
- Updated DLP in accordance with new guidelines to safeguard health information.
Education
High School Diploma -
RCM Gujarati High School
PuneSkills
- Data analysis and EDI processing
- Enrollment verification and eligibility determination
- Problem resolution strategies
- Client relationship management
- Claims processing
- Eligibility verification
- Audit methodologies
- Data reconciliation
- EDI management
Certification
Introduction to Data Analytics
Software
Macess
EAM
Aldera
Jira
SQL
Power BI
Timeline
Sr Enrollment Analyst
Evolent Health International Pvt Ltd
10.2020 - 01.2026
Jr Commercial Officer
Chordia Food Products Ltd
01.2020 - 08.2020
Admin Head
Ruchir Foods
04.2017 - 01.2020
Admin & Billing Head
Shriram Texttiles Mills
12.2015 - 02.2017
Quality Auditor
Trizetto A Cognizant company
04.2013 - 10.2015
Enrollment Associate
Trizetto A Cognizant company
09.2010 - 03.2013
Claims Associate
Trizetto Services India Pvt Ltd
08.2006 - 08.2010
High School Diploma -
RCM Gujarati High School