RISHI KHANUJA
Senior Analyst, Quality
Pune,Maharashtra
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
10
10
years of professional experience
5
5
years of post-secondary education
2
2
Certifications
1
1
Language
Work History
Sr. Audit Analyst
Evolent Health
10.2020 - Current
- Experience of handling Team of 15 people and prepared various reports for the Team
- Preparing Quality reports and Data Analysis on Power BI to identify the latest trends and root cause
- Verifying Configuration issues such as Benefits, Pricing and Plan building and getting them fixed on priority
- Discussed performance review and prepared growth plan for the team
- Involved in setting up the new Process for Organization and Sharing updates on regular basis and filling up the Knowledge Gap of the Internal Teams
- Performed configuration Audit and verified the Provider contract and benefit class
- Interaction with State Site Team for Audit Improvement for maintaining Good Quality Score
- Providing Root Cause Analysis for the Error trends and conduction sessions to fill the Knowledge Gap of the Adjudicators
- Preparing Production report for the Team and making sure everyone is achieving the target with good Quality
- Preparing and presenting Quality Data for the end of each week and month for analyzing the Error trends
- Providing appropriate Feedback to the Adjudicators to reduce the Errors
- Streamlined the process of productivity measures for entire Quality team
- Worked on various projects which leads to save huge dollar amount.
- Ensured compliance with regulatory requirements by conducting in-depth reviews of policies, procedures, and documentation.
- Conducted regular follow-ups on past audit recommendations to evaluate effectiveness of implemented changes and track progress toward resolution.
Subject Matter Expert
Wipro Technologies
04.2018 - 03.2020
- Providing Support to Claim Adjudication team to maintain Good External and Internal Quality
- Sharing Updates on Regular Basis and filling up the Knowledge Gap of Internal Teams
- Handling Calibration Calls with Client
- Interaction with Clients for developing Process Training Guidelines for New Hires
- Payment finalization to the providers (hospitals) as well as individual members who have taken UHC as their Insurance carrier as a Claim Adjudicator
- Need to settle payment for the customers as per the new policies, in cases of changes in the contract of insurance
- Handling Claim Denial Reason and its Resolution like Duplicate, No Authorization, Coverage, Not Covered Service
- Attended calls from the Service Providers regarding Claims Denials and Claim Benefits
- Directly dealing with the Healthcare Service Providers and resolving their queries related to Claims
- Worked on various client projects like Rework Reduction, Interest Audits, etc
- Worked on escalation issues.
- Enhanced team performance by providing expert guidance on critical projects and strategic initiatives.
- Established best practices for knowledge sharing, fostering a culture of continuous learning and improvement.
Senior Associate
WIPRO LIMITED
03.2014 - 03.2018
- Trained and supported new team members, maintaining culture of collaboration.
- Collaborated with cross-functional teams to drive successful completion of complex projects within deadlines.
- Approached each problem with fresh mind and analytical strategies to quickly resolve concerns.
- Mentored junior associates, fostering professional growth and helping them reach their full potential.
Education
Class Xth -
Kendriya Vidyalaya, Panagargh
Panagarh 01.2007 - 03.2008
Higher Secondary XIIth - Commerce
Kendriya Vidyalaya, Panagarh
Panagarh 01.2009 - 03.2010
B.COM (ACCOUNTANCY) - Accounting
Calcutta University
Kolkata 05.2010 - 06.2013
Skills
Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Outlook)
Team Management
Problem-Solving
Teamwork and Collaboration
Advance MS Excel
Power BI
Lean Six Sigma Green Belt certified
Revenue Cycle Management
Power BI and SQL
Quality Tools
Lean Six Sigma Green Belt
Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Outlook)
Accomplishments
Wipro Ltd
- Never charged with any external error since my joining.
- Internal Quality as well as production always remains green.
- Got Runner up award in PCRS Rework Reduction Project in 2017.
Evolent Health International
- Received Employee of the Month Award for the month of Jan' 2023.
- Received “Pat on the Back” Award by the Manager for driving the Quality in the Team
- Participated in Interest reduction project as Team member and reduced Interest Penalty for Texas State.
- Initiated a project for system error reduction and provided ideas related to that to achieve results.
- Appreciated with Star Award for coming up with Spot Ideas for the process improvement.
Personal Information
- Father's Name: Suresh Khanuja
- Date of Birth: 12/31/92
- Gender: Male
- Nationality: Indian
- Marital Status: Married
- Religion: Hindu
Trainings attended
- Tally.ERP9 from Tally Academy, Durgapur
- Email Etiquettes
- Effective Communication Skills
- Writing Effective Skills
- MS Advanced Excel
- Power BI
- Basic SQL
Disclaimer
I hereby declare that the information provided by me is correct to my knowledge and believe and references will be shown if required.
Certification
Power Bi
Timeline
Power Bi
03-2024
Lean Six Sigma Green Belt
08-2023
Sr. Audit Analyst
Evolent Health
10.2020 - Current
Subject Matter Expert
Wipro Technologies
04.2018 - 03.2020
Senior Associate
WIPRO LIMITED
03.2014 - 03.2018
B.COM (ACCOUNTANCY) - Accounting
Calcutta University
05.2010 - 06.2013
Higher Secondary XIIth - Commerce
Kendriya Vidyalaya, Panagarh
01.2009 - 03.2010
Class Xth -
Kendriya Vidyalaya, Panagargh
01.2007 - 03.2008