Praveen M
Coimbatore
Summary
Dynamic Quality Specialist with a proven track record at Sagility Health Care, excelling in quality assurance and process optimization. Recognized for enhancing first-pass yield and achieving 100% SLA compliance. Skilled in data analysis and client communication, driving impactful improvements and fostering team collaboration for superior service delivery.
Overview
5
5
years of professional experience
Work History
Quality Specialist
Sagility Health Care
Bangalore
01.2020 - Current
- Conducted audits for dental, orthodontics, and Medicaid, adjudication (pre & post) claims; ensured adherence to quality benchmarks.
- Managed dedicated accounts and handled high-dollar PG payments, maintaining 100% SLA, and compliance.
- Collaborated with cross-functional teams, including admin intake and encounter capture, for issue resolution.
- Mentored new hires, facilitated onboarding, process training, and quality coaching.
- Delivered process insights using seven QC tools and fishbone diagrams for root cause analysis.
- Reworked denied or escalated claims, and improved first-pass yield by reducing rework.
- Managed client communications and resolved escalations, ensuring service satisfaction.
- Participated in documentation indexing and imaging tasks to support adjudication processes.
- Supported transition efforts in pre- and post-adjudication workflows through collaboration with operations.
- "Top Gun" award recipient for high volume and high-quality performance.
- Earned client appreciation for consistency, process improvement impact, and a good PPT presentation in the calibration meeting with the Onshore SME.
Education
Bachelor of Science - Physics
Muthayammal College of Arts And Science
Namakkal, Tamil Nadu05-2019
Skills
- Team Leadership and People Management
- Process Improvement and Optimization
- Client communication and escalation handling
- Quality Assurance and Auditing (Internal and External)
- Data Analysis (7 QC Tools, Fishbone Diagram)
- Claims management (dental, orthodontics, Medicaid, adjudication)
- SLA/TAT Tracking and Compliance
- Cross-functional communication
- MS Office Suite
- Regulatory compliance
- Team collaboration
- Problem solving
- Corrective actions
- Performance monitoring
- Audit reports
Additional Information
Open to relocation within company locations., Fast learner with a collaborative mindset, Familiar with adjudication cycle and encounter-to-payment workflows.
Personal Information
- Date of Birth: 03/29/99
- Marital Status: Unmarried
Languages
Tamil
First Language
English
Proficient (C2)
C2
Malayalam
Intermediate (B1)
B1
Timeline
Quality Specialist
Sagility Health Care
01.2020 - Current
Bachelor of Science - Physics
Muthayammal College of Arts And Science
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