RAKESH KUMAR
Benefits Operation Manager (Assistant Manager)
Shahadra
Summary
Subject matter expert role/ Benefits Analyst role in U.S. Benefits Administration in Health & Welfare domain or HCM benefits Administration.
Experienced with benefits administration and operational management. Utilizes strategic planning to streamline processes and improve service outcomes. Track record of driving efficiency and ensuring compliance in complex benefits environments.
Overview
15
15
years of professional experience
6012
6012
years of post-secondary education
Work History
Benefits Operation Manager
Wipro (Alight Solutions)
Noida
05.2020 - 04.2025
- Administer health insurance plans including medical, dental, vision, and wellness programs.
- Assign and manage BOA work, including workload distribution, track status of outstanding work, ensure SLA metrics are met/ exceeded, identify training opportunities, review, and approve SOPs, identify activities for transition to OCP/ Shared Service
- Identify growth areas for BOAs and provide opportunities in those areas.
- Planning, designing, implementing, evaluating, and managing health and welfare benefits for the US based clients.
- Work closely with testing team and be aware of uncompleted cases, make sure defect fixing in proper TAT, and take good use of every batch
- Managing maintenance and auditing of employee personnel files and departmental files (vendors, contacts, etc)
- Monitoring and ensuring strong business controls are met adhere corporate directives.
- Driving process improvement harmonization and effectively managing changes.
- Managing team member, BOA, SDA and CSR queries, provide them training, creating SOP for ongoing process or newly added task INDIA.
- Provide feedback to SDA, BOA/Team member and CSR on client and employee escalations.
- Quality check of Death claims, client report, issue trackers workflows COBRA enrolment & 401K and daily ongoing manual task processed by BOA/ team members.
- Death claim Process based on 2-year benefits (Life and AD&D Plan for PPT, child life and child AD&D for child and spouse life spouse AD&D for spouse) also review their EOI (Evidence of Insurability) status.
- Working and reviewing High Risk Processes to ensure compliance to Federal regulations using workday and MSS tool. At the time of LOA employee’s queries using workday tool to know exact leave status.
- Executed identification, submission, monitoring, and examination of calculations engine defects.
- Maintaining and sustaining client health and score card.
- Discussing process health and improvement areas with Onshore and Offshore Leaders and sharing plan/ strategy for each quarter.
- Payroll calculation (Weekly, Biweekly and Monthly), Ensuring whether it should be Pre-tax or Post-tax.
- Reviewing RI (Rapid Implementation) and get it updated based on client requirement.
- Works on none payment of COBRA premiums.
- Ensuring Retirements and Dependent Age out. If Dependent were getting age out then updating the data on workday tool.
- Worked on Dependents Verification, Life Events and DV denial.
- Worked on Carrier error reports or discrepancies reports.
- Worked on Census or HR feed file. If any changes needed in the personal details or employment data related then we were using the workday to update the data.
- Worked on Issue Tracker and Support mailbox. Resolve HR-related help requests in a timely and empathetic manner.
- Specialize in working LTD and STD reports via using Workday and MSS tool both.
- Works on Direct billing and payments reports.
- Ensuring surcharges (Spousal surcharge and Tobacco surcharge).
- Ensuring the funding of all the FSAs Accounts (DCFSA, HCFSA).
- Working on all the QLE (Qualified life events).
- Works on all the Pre-tax accounts (HSA, HCFSA, DCFSA, LPFSA).
Solution Delivery Analyst
Wipro (Alight Solutions)
Noida
06.2017 - 04.2020
- Premium billing client and carrier report and Premium billing calculation and error correction. To make the correction fetching reports from workday tool.
- Quality check of Death claims, client report, issue trackers workflows COBRA enrolment & 401K and daily ongoing manual task processed by BOA/ team members.
- Death claim Process based on 2-year benefits (Life and AD&D Plan for PPT, child life and child AD&D for child and spouse life spouse AD&D for spouse) also review their EOI (Evidence of Insurability) status.
- Working on Two clients as primarily and working on two clients as backup.
- Primary point of contact between employees and vendors or Carriers.
- Organizing client calls to discuss Participant logs and ongoing issues.
- Managing and administrate all the health traditional Medical, Dental, Vision, Disability plan, STD (Short term disability), LTD (Long term disability), (included EOI approval/Denial manual process)
- In depth research and analysis of participant issues ie health plan enrolment, cobra rate, portal issue, cobra enrolment, Life and AD&D Pan enrolment.
- Trained on Rate calculation for active retire and COBRA participants.
- Manual calculation of retro charges or refund so that it would be sent via EIB.
- Payroll calculation (Weekly, Biweekly and Monthly).
Benefits Operation Administrator
Wipro (Alight Solutions)
Noida
12.2014 - 05.2017
- Updated and reviewed RI (Rapid Implementation) based on client requirements- Addressed non-payment of COBRA premiums to ensure compliance- Managed retirements and dependent age outs for accurate record-keeping.
- Verified dependents, managed life events, and addressed DV denials- Handled carrier error and discrepancy reports to ensure data accuracy. Managed census and HR feed files for benefits administration. Tracked and resolved issues using the Issue Tracker and Support mailbox. Specialized in generating LTD and STD reports for analysis- Processed direct billing and payment reports for accounts accuracy.
- All kind of SOP based worked of audit reports for benefits.
Sr. Executive
EXL Services Pvt. Ltd.
Noida
02.2010 - 11.2014
- Responsible for the accurate processing and completion of insurance medical invoice and Creating Workflows.
- Processed the ad hoc reports as per Management required.
- Executes issue resolution and ensures proper documentation and follow-up takes place.
- Make the payment for the Hospital bills and physician bills.
- Develops and maintains process documentation/SOP to ensure compliance of standards.
- Mentoring support to team associates.
- Pricing the claims through specific price’s and apply plan benefit as per the contract.
- Performing pre-adjudication edits which involve checking the claim status with respect to duplicate claims, timely filing of the claim, patient age (dependent/fulltime student specification), pre-existing conditions, pre-certification, other insurance plan flag, employment related accident, other accident claim etc.
- Work Profile: property and Causality
- 4 years of work experience in P&C insurance. Worked for the first party M.V.A. (Motor Vehicle Accident) injuries. My core responsibility was to reimburse payment the medical provider for the services they rendered to the patients which are enrolled with a client. Required to investigate invoice and bill summary and correlate the billed charges for submitted medical records followed by the claim processing related to MVA then we issue the check and if not then we deny the payment bill with reason of denying.
Education
Bachelor of Arts - Arts
Ramjas College
Delhi University05.2006
12th - Arts
CBSE Board
CBSE Board05-2006
10th -
Ramjas No 1
CBSE Board05.2001
Skills
Over 10 years of solid experience in US benefits administration within the Health & Welfare domain Proficient in managing active benefits such as Medical, Dental, Vision, FSA, HSA, and Life Insurance plans, as well as COBRA benefits and ACA Along with end-to-end onboarding (New Hire) to retired/terminated process Experienced in premium invoice reconciliation and client implementation processes
- Hands-on experience in testing Benefits validation and Annual enrollment processes, ensuring accurate configuration and system functionality
Proficient in data analysis using Advanced Excel functions and Power BI for generating and delivering client-facing reports related to benefits review Also using workday and MSS to fetch the custom reports to provide the clarity to client about the employee benefits
Project Management testing/VaDocumentation Creating SOPs, training materials, and audit trails Problem Solving: Addressing errors in premium reports and in census files Using tool Workday and MSS to work on employee personal details and to get the benefits details Client provide access to check the benefits deduction from the pay check
- Problem solving, time management and priority setting skills
- Ensure compliance with applicable federal and state regulations including HIPAA and COBRA
- Collaborate with stake holders/service providers and carriers to manage client premium reports, carrier/vendor premium reports, and carrier premium error reports
Vendor relationship management
Data analysis proficiency
Team leadership experience
Accomplishments
- Appreciation mail from client’s team for creating Create shortcuts to increase production for process to remove manual steps.
- Received 4 ‘Rewards & Recognition’ for continuous excellent performance.
PERSONAL DETAILS
- Father’s Name: Mr. C.S. Dhirwal
- Date of Birth: 1985-03-24
- Marital Status: Married
- Address: 1/6074, East Rohtash Nagar shahadra New Delhi-110032
- Date:
- Place: Delhi
Timeline
Benefits Operation Manager
Wipro (Alight Solutions)
05.2020 - 04.2025
Solution Delivery Analyst
Wipro (Alight Solutions)
06.2017 - 04.2020
Benefits Operation Administrator
Wipro (Alight Solutions)
12.2014 - 05.2017
Sr. Executive
EXL Services Pvt. Ltd.
02.2010 - 11.2014
Bachelor of Arts - Arts
Ramjas College
12th - Arts
CBSE Board
10th -
Ramjas No 1
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