PRERANA SANEM
Hyderabad
Summary
Dedicated and detail-oriented professional with over 5.3 years of experience in healthcare, specializing in Provider Data Management. Seeking a challenging position to leverage my skills in data analysis, accuracy, and process improvement within a dynamic healthcare environment.
Overview
5
5
years of professional experience
Work History
Quality Control Analyst
Carelon Global Solutions
Hyderabad
07.2024 - Current
- Planned and monitored auditing transactions, identifying system improvement areas.
- Analyzed root causes for downstream and upstream impacts with operations leaders.
- Conducted five why analyses to enhance quality standards among associates.
- Analyzed upstream and downstream impacts to devise action plans with operations leaders, ensuring effective root cause resolution.
- Planned and executed audits to identify and implement system improvements.
- Delivered feedback using proofing techniques to improve data accuracy and process quality.
- Conducted end-to-end audits and partnered with Data Engineering for automation of mistake-proofing measures.
- Applied DMAIC and sampling methodologies to drive process enhancements and quality assurance compliance.
- Utilized Excel and quality tools to support data-driven decision-making and continuous process improvements.
- Gained in-depth exposure to quality frameworks, audit strategies, and healthcare operations.
- Handled claims inquires- Reviewed provider claim inquiries and analyzed claim status, denials and payment outcomes.
- Verified claim processing accurancy in accordance with payer guidelines and business rules.
- Coordinated with health plans and internal teams to resolve claim reprocessing and adjustment requests.
- Documented investigation findings and communicated clear claim resolution to providers.
- Maintained productivity and quality standards.
Associate Provider Data Management
Carelon Global solutions
Hyderabad
03.2021 - 05.2024
- Maintained accurate provider information across claims and databases.
- Assisted in synchronizing data among multiple claims systems while applying business rules.
- Collaborated with cross-functional teams to ensure up-to-date provider information.
- Utilized data management tools to optimize workflows and enhance efficiency.
- Implemented process improvements, achieving 15% reduction in data errors.
- Communicated with providers to gather necessary information and resolve discrepancies.
- Documented end-to-end processes for macros and automation.
- Participated in UI testing for automation alongside onshore teams.
Education
Bachelor of Pharmacy -
Samskruti College of Pharmacy
Ghatkesar, Telangana11-2020
Intermediate Public Examination - Science
Sri Chaitanya Junior College
Hyderabad01-2016
Secondary School Certificate -
Sujatha High School
Hyderabad01-2014
Skills
- MS-Office Suite
- Data analytics and reporting
- Power BI and Tableau
- Six Sigma methodology
- SQL Beginner's level
Accomplishments
- Awarded thrice as "The Powerhouse" for operating within a team and received positive feedback from the entire span.
- Won "The Musketeer" Award for meeting expectations and contributing to the success of the business.
- Recognized for outstanding contributions to data accuracy and process efficiency.
Accomplishments
- Organized various Sports and Cultural activities at the college level.
- Engaged actively in school competitions, including essay writing and quiz.
contests.
Skills
- Mentoring and coaching
Hobbies
- Dancing.
- Cooking.
- Listening to music.
- Swimming.
Languages
- Telugu
- English
- Hindi
Timeline
Quality Control Analyst
Carelon Global Solutions
07.2024 - Current
Associate Provider Data Management
Carelon Global solutions
03.2021 - 05.2024
Bachelor of Pharmacy -
Samskruti College of Pharmacy
Intermediate Public Examination - Science
Sri Chaitanya Junior College
Secondary School Certificate -
Sujatha High School