Ram Nath Sah
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Senior Claims Associate
Optum
03.2018 - Current
- Handling end-to-end claims adjudication and financial transaction processing within a high-volume, compliance-driven environment, ensuring accuracy, regulatory adherence, and operational efficiency.
- Managing complex claim approvals, denials, medical records and documents and correspondence reviews while ensuring strict compliance with internal control frameworks and regulatory standards.
- Monitoring Service Level Agreements (SLAs), turnaround time (TAT), inventory control, and productivity metrics to ensure optimal workflow management and service excellence.
- Preparing Work Force/ Management Information System (WFM/MIS) dashboards, performance reports, and operational analytics for management review, supporting data-driven decision-making.
- Performing quality audits, root cause analysis, and risk assessments to identify process gaps and implement corrective action plans.
- Mentoring and guiding team members, conducting performance monitoring, training new hires, and driving adherence to quality and compliance benchmarks.
- Leading calibration sessions and workforce performance reporting in collaboration with onshore stakeholders to enhance service delivery standards.
- Interpreting employer-sponsored and individual policy benefits to ensure accurate adjudication and informed financial decision-making.
- Streamlining workflows within universal billing systems to improve operational efficiency and enhance customer satisfaction.
- Acting as a key point of contact for cross-functional coordination, managing escalations and ensuring timely resolution within Service Level Agreements (SLAs) parameters.
Claims Associate
UnitedHealth Group
04.2015 - 02.2018
- Evaluated and processed complex U.S. benefit claims, ensuring strict adherence to policy provisions, regulatory requirements, and precise liability determinations.
- Interpreted intricate policy language to facilitate accurate financial disbursements and validated claim documentation against coverage limits to prevent overpayments.
- Managed high-volume service requests and claim disputes, streamlining investigation processes to improve resolution efficiency and customer satisfaction.
- Optimized reconciliation workflows for member accumulations, including deductibles and out-of-pocket maximums, effectively reducing manual errors and processing delays.
- Collaborated on workflow enhancements that accelerated claim turnaround times (TAT) while consistently maintaining top-tier quality-audit scores.
Trainee Associate
WNS Global Services
04.2014 - 09.2014
- Developed foundational knowledge in standard operating procedures (SOPs) and organizational workflows.
- Contributed to successful project completion by providing timely support as needed.
Education
MBA - Finance & Insurance Management
Indian School of Business Management & Administration
(ISBM), AEREN FOUNDATION's Bachelor of Commerce -
Shobhit Institute of Engineering & Technology
Shobhit UniversityPCL -
Tribhuvan University
10+2 Proficiency Certificate LevelSLC -
NATIONAL EXAMINATIONS BOARD
10th School Leaving Certificate Skills
Communication
Human Resource Management
Leadership
Problem Solving
MS Office Package & BI Reporting Tools
Finance & Data Analytics
Quality & Productivity
Standard Operating Procedure
Critical Thinking & Motivation
Collaboration
Smart Goals (Measurable-Achievable-Realistic & Time Bound)
Certification
Six Sigma Green Belt Certified
Key Achievements
- Process Efficiency Increase: Enhanced process efficiency by 30% during project duration.
- Quality Audit Excellence: Achieved 98% accuracy in quality audits for three consecutive quarters, exceeding targets.
- Productivity Enhancement: Led a team to improve workflow, increasing productivity by 15% in six months.
- Honors & Awards: Recognized with multiple awards for outstanding contributions in the workplace.
Timeline
Senior Claims Associate
Optum
03.2018 - Current
Claims Associate
UnitedHealth Group
04.2015 - 02.2018
Trainee Associate
WNS Global Services
04.2014 - 09.2014
MBA - Finance & Insurance Management
Indian School of Business Management & Administration
Bachelor of Commerce -
Shobhit Institute of Engineering & Technology
PCL -
Tribhuvan University
SLC -
NATIONAL EXAMINATIONS BOARD