RAHUL PT
Gurugram
Summary
Dynamic professional with a proven track record at Carelon Global Solutions, excelling in operational efficiency and team support. Adept at analyzing complex insurance documents and training new associates, leveraging strong communication and organizational skills to drive quality improvements. Recognized for enhancing process flow and resolving conflicts effectively.
Overview
10
10
years of professional experience
Work History
Subject Matter Expert
Carelon Global Solutions
Gurugram
01.2023 - Current
- Resolved team member queries and provided on-floor support.
- Developed quality improvement initiatives to enhance operational efficiency.
- Managed multiple inventory levels and quality reports, presenting findings to management in accordance with requirements
Benefit Analyst
Legato Health Technologies
12.2019 - 12.2022
- Review and analysis of insurance plan documents prepared by the benefit design analysts.
- Analysis of insurance plan documents and sales documents to determine member responsibilities namely copay, coinsurance and deductible.
- Integrate essential health benefits, prior authorization requirements, state specific regulations and resolve information source conflicts.
- Trained newly joined associates and provided buddy support during the ramp up phase.
- Maintained inventory reports and ensured smooth process flow by coordinating with onshore partners and vendors.
- Facilitating regular team meetings/huddles and skip level meetings to ensure that high level of regular and timely communication exists within the team.
Claims Administrator
Mayfair Consultancy Services
04.2017 - 12.2019
- Reviews and enables claim forms and accurately enters the claim details into the system database.
- Addressing queries of the members through phone and email.
- Clearing pending claims for the team on receipt of required documents.
- Internal audit responsibilities and acted as floor support for new associates.
Process Executive
Cognizant Technology Solutions
07.2015 - 11.2016
- Completes enrollments and dis-enrollments.
- Being a part of monthly, quarterly Quality review meeting in order to know the Quality scores, root causes for the errors and also come up with necessary action plans.
Education
BACHELOR OF COMMERCE - COMPUTER APPLICATION
KANNUR UNIVERSITY
KERALA03.2014
Skills
- Strong interpersonal and communication skills
- Excellent organizational skills
- Ability to work collaboratively as part of a team
- Poised under pressure
Hobbies and Interests
- Movies
- Football
Timeline
Subject Matter Expert
Carelon Global Solutions
01.2023 - Current
Benefit Analyst
Legato Health Technologies
12.2019 - 12.2022
Claims Administrator
Mayfair Consultancy Services
04.2017 - 12.2019
Process Executive
Cognizant Technology Solutions
07.2015 - 11.2016
BACHELOR OF COMMERCE - COMPUTER APPLICATION
KANNUR UNIVERSITY
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