Rahul Bhimrao Makamle
Navi Mumbai
Summary
To get an opportunity where I can make the best of my potential and contribute to the organization's growth.
Overview
10
10
years of professional experience
Work History
Transaction Processing Associate
BCBS NC ( US Healthcare insurance)
02.2023 - Current
- Managed NPM application for accurate demographic data preparation of providers for seamless claims settlement.
- Co- ordinated with Providers,Payers,and Internal Teams to resolve billing or claims discrepancies.
- Corrected demographic and financial address details based on provider requests.
- Updated provider demographic information in database to ensure accuracy and compliance.
- Cross-trained in databases including Maccess, Amysis, and NPM for Medicaid and Medicare processes.
- Processed updates such as Tax ID, Specialty, NPI changes, and new addresses efficiently.
- Maintained up-to-date provider information across multiple databases to support operational integrity.
- Generated correspondence emails and welcome letters to inform providers of updates.
- Good understanding of U.S healthcare insurance plans including HMO,PPO,EPO and Medicare and Medicaid.
Transaction Processing Associate
Atrio ( US Healthcare insurance)
09.2022 - 01.2023
- Work on Health edge Designer and Health edge Manager Application.
- PDM is responsible for the accurate and timely maintenance of provider information on all databases for Payers to ensure smooth and efficient transactions.
- Analyze and validate data, update records, store documents, ensure data security.
- Worked with insurance domain,supporting financial and operational processes related to Billing ,Claims,or Policy administration.
- Work to Assist Insurance transactions, documentation,and System Updates to ensure accuracy and compliance.
Transaction Processing Associate
ANTHEM ( US Healthcare insurance )
09.2017 - 09.2022
- Developed Health Edge Designer and Health Edge Manager applications for improved functionality.
- Ensured accurate and timely maintenance of provider information across all databases for Payers.
- Handled premium payments,Patient responsibility,Copay,Deductible and Co- insurance .
- Experience working with insurance domain, Supporting financial and operational Process related to Billing,Claims and Policy Administration.
- Hands on Experience in US Healthcare insurance operations, payment processing and system updates.
- Familiar with US Insurance workflows, Terminology and Financial controls across multiple insurance functions.
- Analyzed and validated data, updated records, secured documents, and submitted data for audits.
- Compiled inventory data of state-specific providers for Medicare CA, GA, and PDM Medicaid offshore CA, WV.
- Trained team members on update procedures to enhance operational efficiency.
- Allocated Provider Requests to associates while monitoring progress and status updates.
- Prepared daily Minutes of Meeting reports for distribution to team members and leadership.
- Strong understanding of Us HealthCare insurance operations and Billing workflows.
Transaction Processing Associate
05.2016 - 09.2017
- Handling exceptions created due to incorrect gas and electricity supply transfers between suppliers in UK.
- Managing disputes raised by the customers for getting the correct opening or closing reads accurately updated on their accounts.
- Solving queries of team members.
Education
Bachelor of Commerce -
Mumbai University
HSC -
Maharashtra State Board
SCC -
Maharashtra State Board
Skills
- MS Office (Word, Excel & Power Point)
- Excel Using Certification through AI
- SQL Server 2008
- Ability to Multitask
- Decision Making
- Knowledge of Office Systems
- SAP Version 72
- Quick Learner
- Team Handling
Achievements Awards
- Awarded as encore awards for 2 consecutive quarters for meeting best productivity and quality in Anthem Deal from Accenture.
- Awarded as Star of Business award for one quarter for meeting best productivity and quality in Anthem Deal from Accenture.
- Awarded as encore awards for 2 consecutive quarters for meeting best productivity and quality in BCBS Deal from Accenture.
Languages
- Marathi
- Hindi
- English
Timeline
Transaction Processing Associate
BCBS NC ( US Healthcare insurance)
02.2023 - Current
Transaction Processing Associate
Atrio ( US Healthcare insurance)
09.2022 - 01.2023
Transaction Processing Associate
ANTHEM ( US Healthcare insurance )
09.2017 - 09.2022
Transaction Processing Associate
05.2016 - 09.2017
Bachelor of Commerce -
Mumbai University
HSC -
Maharashtra State Board
SCC -
Maharashtra State Board