Pragati Singh

I. Value Quantification[January'24-Present]

Deliver Value story enhancements around the supplemental models.

• Identify areas where services / cost can be analyzed and translate insights into business value.
• Understand how the business is currently performing and help analyze different value generating KPI's like gap closed values,actual value,enrollment rate.

II. Proactive Intercept Campaign[April'23 - Present]

Built a consistent measurement platform that will study process effectiveness and value for each campaign.

• Develop a generic framework for measurement of campaigns across common program metrics.
• Perform Value studies based on analytical approaches for specific programs.
• Insights would drive business decisions with respect to refining process gaps,scaling up/down campaigns,designing future campaigns.

III. Root Cause Analysis [April'23-Present]

Identify and prioritize issues that impact Customer, establish their root cause and provide findings and recommendations for business improvement.

• RCA program initiatives : Establish true root cause of issues impacting customer and propose / recommend business improvements to remediate these issues. Additionally responsible for maintaining quality aspects of RCA process and developing unique solutions that will help reduce reoccurring incidents.
• Collaboration with Business : Liaise with key business process owners and business partners, conduct risk and compliance across business to share findings and identify business improvement activity to address root cause. Support key stakeholders / process owners to track and assess results of improvements to ensure desired outcomes have been met.

I. Dashboard Reporting[August'21-March'23]

Access, evaluate and comprehend heterogeneous data to seek valuable insights.

• Studying Performance Analytics : Built interactive tableau dashboards that help efficiently understand and interpret data. Made informed decisions by combining data from Prior Auth's, Appeals, Claims, Survey and Calls monthly trends into single insightful tableau dashboard with subcategory and quarter-wise heatmap– allowing business to take goal-oriented actions.
• Development and Reporting : Built dynamic reports and dashboards for in-depth analysis as well as insight gathering.

✓ identifying quick resolving query patterns among reps, situational awareness of calling patterns and operational capacity to effectively achieve lower repeated calls and improve call resolution rate with lower average handling time.

✓ Determining key metrics impacting member experience and other forms of customer feedback e.g. NPS , UES ,Satisfaction Score ,Resolution Score.

✓ Investigating Prior Auths's for studying procedures, providers and reasons impacting member experience.

✓ Deep dive analysis of Appeals to understand trend, reasons of upheld, proportion of pre/post service appeals.

Planned, designed, and implemented automation of FWA business process
I. Fraud/Waste and Abuse-Poland [June 19-August 21]

works to identify fraud,waste and abuse in healthcare sector and recover leakages.
• Initiative to increase company's profit through Fraud/Waste/Abuse scenarios : Conducted deep analysis for understanding of scope and integrated business solution for FWA scenarios. Also, implemented these solutions through an analytical technical platform.
• Interaction with stakeholders: Conducted stakeholder meetings, interviewed business clients to analyze their business requirements and designed technical solutions to business process
• Qualitative and quantitative analysis of business data: Construction of analytical data set based on understanding of FWA scenarios in order to improve quality of data which consecutively benefits both customers as well as team. This analytical data set contains data for information to be reported in user interface of FWA utility. This engine acts as brain behind different interfaces.
• Excel-VBA based utility: Single handedly developed an Excel-VBA based utility which connects and communicates SQL database for understanding/visualizing and reporting of trend and information.
Key Features of Excel VBA utility:
✓ Provided tool with an advanced write back feature.
✓ Integrated automatic email alerts for all red flagged cases.
✓ Report generation-based Fraud/Waste and Abuse hypothesis.
✓ Clickable PIN to show complete history of a case.
✓ Enabled Password Protection feature to protect utility from data leakage.
II. Provider Monitoring Report-Greece [August 20-August 21]
capability to slice and dice data by multiple dimensions like time / business groups / demographics etc.

• Development and reporting: Designed, developed, and deployed business analytics dashboards using Microsoft BI technologies including SQL server, power BI, excel etc. Report aimed to build interactive and actionable dashboards that helped in deriving meaningful business insights from large, complex datasets