ROBIN XAVIER FERNANDES
Bengaluru
Summary
Operations and Quality Specialist with 7 years 2 months of experience in US healthcare claims and Revenue Cycle Management (RCM). Experienced in claims processing, claims adjudication, denial management, quality checks, audit support, process improvement, and team support.
Overview
3
3
Languages
3
3
years of post-secondary education
8
8
years of professional experience
Work History
Quality Specialist - Grievance & Appeal Process
Sagility
Bengaluru
03.2026 - Current
- Prepared daily QA reports, tracking quality performance to identify trends and areas for improvement.
- Support internal and external SLA requirements.
- Participate in client calls and understand quality requirements.
- Identified processing errors, supporting corrective actions to enhance overall accuracy.
- Communicated common mistakes to training team, facilitating targeted improvements in training programs.
- Assisted in conducting internal audits to ensure compliance with quality standards., calibration, and process compliance.
- Work with operations teams to improve accuracy and reduce errors.
- Perform quality checks to make sure claims are processed correctly.
- Conducted regular audits to identify areas for process improvement.
Operations Specialist
Sagility
Bengaluru
01.2022 - 03.2026
- Managed client requirements while ensuring adherence to process and compliance guidelines.
- Executed automation tasks to enhance operational efficiency. and process improvements.
- Improved team productivity by checking queries and streamlining workflows.
- Managed bulk claims batch loading to reduce manual work and processing time.
- Facilitated healthcare claims processing as a Subject Matter Expert (SME).
- Processed and reviewed claims payments based on provider agreements.
- Evaluated healthcare reimbursement processes for accuracy and compliance., contracts, payment policies, and guidelines.
- Addressed and resolved provider requests and claim-related issues to maintain service quality.
Senior Process Consultant
Hinduja Global Solutions (HGS)
Bengaluru
01.2019 - 01.2022
- Processed US healthcare claims ensuring compliance with client requirements.
- Monitored key performance indicators (KPIs) to assess process performance and identify improvement opportunities.
- Supported quality and process improvement initiatives to enhance operational effectiveness.
- Processed US healthcare claims based on client requirements.
- Checked claims payments against provider terms.
- Monitored key performance indicators (KPIs) to evaluate process performance and highlight areas for improvement.
Education
Bachelor of Commerce - Accountin
Kuvempu University
Sagara, Karnataka 06.2015 - 07.2018
Pre-University (10+2) -
K.P.T.C.L Pre-University
Jog FallsSkills
- Healthcare claims processing
- Claims adjudication
- Claims payment review
- Quality audit support
- Audit support
- Revenue Cycle Management (RCM)
- Process improvement
- Claims processing efficiency
- Provider and Payer Processes
- Data interpretation
- Basic SQL
- MS Office
- Analytical thinking
- Team coordination
- Issue resolution
- Documentation management
- Audit reports
Accomplishments
- Received 4 TOP GUN Awards for highest production with zero errors.
- Received 5 Best Buddy Awards for supporting and mentoring new associates.
- Received 1 Spot Award for good performance.
Languages
Kannada
Proficient
C2
English
Advanced
C1
Hindi
Beginner
A1
Disclaimer
I hereby declare that the above information is true to the best of my knowledge and belief.
Robin Xavier Fernandes
Timeline
Quality Specialist - Grievance & Appeal Process
Sagility
03.2026 - Current
Operations Specialist
Sagility
01.2022 - 03.2026
Senior Process Consultant
Hinduja Global Solutions (HGS)
01.2019 - 01.2022
Bachelor of Commerce - Accountin
Kuvempu University
06.2015 - 07.2018
Pre-University (10+2) -
K.P.T.C.L Pre-University