Naveen Kumar R

PMP-Certified Quality and Process Improvement Specialist – Roles & Responsibilities

• Lead the review, analysis, and testing of data quality and operational efficiency using relevant tools, macros, and methodologies, ensuring alignment with project objectives.
• Identify process gaps, errors, and defects; develop actionable plans to enhance quality and effectiveness in line with customer expectations and organizational standards.
• Plan, execute, and monitor quality audits; analyze results, and escalate findings as per defined escalation protocols to support continuous improvement.
• Oversee and evaluate team outputs; prepare improvement roadmaps and action plans to address performance gaps.
• Manage high-priority client projects end-to-end, ensuring the delivery of high-quality outcomes within defined scope, timeline, and cost constraints.
• Serve as a primary point of contact for resolving queries across global Business Analysis and Transformation (BAT) teams.
• Mentor junior quality auditors and conduct structured internal audits to ensure compliance with quality standards and audit protocols.
• Facilitate bi-weekly internal calibration sessions aimed at reducing process errors and driving performance improvements.
• Drive and support continuous process improvement initiatives, contributing innovative ideas aligned with organizational goals.
• Plan and conduct quality process audits for quality auditors, analyze outcomes, and implement improvement recommendations where necessary.
• Develop and deliver training programs and coaching sessions on quality processes, tools, and best practices.
• Maintain and regularly update quality audit tools and repositories used by the team to ensure operational accuracy and efficiency.
• Share cross-functional best practices with onshore teams to foster knowledge transfer and support departmental goals.
• Collaborate with internal stakeholders to support strategic business development and transformation initiatives.
• Work with cross-functional teams to design, develop, and implement automation tools and solutions that drive efficiency and scalability.

• Handled backlog reduction and claims support for Optum Health processes, including Billing EFT and Correspondence.
• Researched and resolved customer account and medical claim issues.
• Interpreted contract terms and analyzed Excel data for issue resolution.
• Delivered accurate claims information and client support.
• Strong problem-solving, communication, and time management skills.
• Proven ability to work efficiently in fast-paced, high-visibility environments.

• Resolved customer inquiries, service issues, and escalations efficiently.
• Supported team operations, conducted new hire training, and maintained feedback records.
• 2+ years of experience with strong multitasking, organization, and teamwork skills.