Rupesh Kumar
Bhubaneshwar
Summary
Results-driven Senior Manager Healthcare Claims with over 19 years of experience in US healthcare for providers and payers. Specialises in operational management, strategic planning, and process improvement, leading teams of over 750 associates while managing annual P&L of approximately £14.4 million. Holds an MBA in Healthcare and a background in Mathematics, committed to fostering organisational growth and service delivery.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Senior Manager Healthcare Claims, Payer and Provider
Wipro Ltd.
04.2023 - Current
- Led operations for 3 of top 5 commercial payers, overseeing 750+ associates, 6 Managers, 35 Assistant Managers, and 45+ subject experts in automation and workforce management.
- Managed annual PnL of approximately £14.4 million, ensuring financial targets were met and aligned with strategic objectives.
- Monitored staff performance and developed improvement plans.
- Advised senior management on facilities needs and delivered ongoing operational support.
- Managed organisational resources to meet administrative and operational needs whilst adhering to budgetary guidelines and meeting quality and schedule demands.
Manager – Healthcare Claims, Enrolment services, Provider pricing configuration, Claims regression testing & product configuration
Concentrix Daksh Services India Pvt. Ltd.
07.2006 - 04.2023
- Managed healthcare payer and provider operations, overseeing client services including benefit configuration, billing installation, and claims processing.
- Leading a team of 350+ which completes the claims set up, coverage verification & adjudication for a US based Health insurance for Medical as well as Dental.
- Ensure adherence to BPM Healthcare Operations standards, emphasizing benefit configuration, pricing configuration, claims testing, and claims administration.
- Spearheaded process improvement projects, including Lean Six Sigma initiatives, achieving 15% efficiency gains, 20% additional business growth through headcount and revenue expansion and Reduced attrition by 12% through structured engagement programs, focus group discussions, and career development plans.
- Directed Lean and Six Sigma campaigns for productivity enhancement and root-cause analysis to ensure corrective/preventive actions were in place.
- Collaborated with stakeholders to identify business impact areas and initiated improvement programs to address inefficiencies in service delivery.
- Work with customers and internal teams (IT / Training / Recruitment / HR / Admin) to resolve issues.
- Preparing Impact studies for Change Management Requests (CMR), from quality, training and operational perspective and implementing the required changes to the process.
- Managed performance evaluations and career development for team members.
- Forecasting Manpower Requirements and coordinating with the recruitment team to ensure delivery of requisite staff.
- Coordinated with process senior managers to plan organisational structure and ensure effective delivery within budget.
- Prepared and implemented the BCP plan, conducting cold and hot tests as per the frequency agreed with the client.
- Leverage extensive industry experience to manage healthcare operations efficiently, particularly from a third-party and in-house Shared Service Centre perspective.
- Delivered BI of ~$0.3MM by driving assisted AI development.
- Created Intelligence enterprise level dashboards using Power BI.
- Commercial payers with a team of 350+ associates and managers. My job is to lead Operations Delivery, drive improvement in SLA performance, customer experience & to take care of the entire site as a site leader.
Education
MBA - Healthcare Management
MU
01-2021
B.SC - Mathematics (Hons.)
MU
01-2007
12th -
Sainik School Tilaiya
01-2002
10th -
Sainik School Tilaiya
01-2000
Skills
- Claims processing
- Operations management
- Process improvement
- Cost efficiency
- Performance management
- Healthcare project oversight
- Resource allocation
- Financial budgeting
- Business continuity planning
- Data analytics
- Forecasting
- Client relationship management
- Client account management
- Cross-functional communication
- Strategic planning
- Strategic thinking
- Digital transformation
- Change management
- Organisational change management
- Project delivery reporting
- Cost efficiency
- Data-driven decisions
- Problem resolution
- Employee engagement initiatives
- Feedback implementation
- Team leadership
- Multi-dimensional team leadership
- Leadership skills
- Quarterly company planning
- Market insights
- Customer strategy design
- Customer service excellence
- Ethical conduct
- Inventory management systems
- Market insights
- Contract management
- Quarterly company planning
- Ethical conduct
- Inventory management systems
Languages
English
Hindi
Certification
- Six Sigma Certified
Interests
- Listen Indian music
Accomplishments
- Awarded 'TOP TALENT' for four consecutive years in quality & Operation and got a chance to meet Senior leadership.
- Received ‘Annual Award’ for showcasing outstanding 'Leadership Excellence'
- Awarded as Best Leader and got a chance to spend holiday with Top Senior Leadership at Goa.
- Cross trained on all the 1st & 2nd touch with RCM different Line of Business
- Received many appreciations from clients
- Awarded as 'Quality Shining Star' & 'Operation TOP GUN'.
- Part of the common Minimum practices team for Claims in Concentrix.
- Received the UHG H1 & H2 award in 2010 for significant contributions made towards process quality improvement.
- Received ‘Gold award” Q3 2009 for outstanding contribution towards enhancing customer experience.
- Received ‘Silver award’ Q3 2007, Q2 2008, Q1 2010 & Q4 2011 for significant contribution made by the team.
- Awarded as 'Operation Going Extra Mile' for Q2 2009, Q3 2010, Q2 2012 & Q1 2014.
- Awarded as Best Support during the time of Covid 19 (Pandemic).
- Transport Spoc and played an instrumental role in reducing 'No Show' for loss of revenue.
- IT Spoc from client side for testing as well developmental training spoc.
Custom
US B1 & B2 VISA valid till 1st Jun 2035, Passport Number- W5779660 valid till 9th Nov'2032
Personal Information
- Father's Name: Late Maj. Jugeshwar Singh (Died in Kargil War)
- Spouse - Jyoti Gautam(Working as Project HR Manager in MSF)
- Child Name: Varenya Bhardwaj(13yrs)
Timeline
Senior Manager Healthcare Claims, Payer and Provider
Wipro Ltd.
04.2023 - Current
Manager – Healthcare Claims, Enrolment services, Provider pricing configuration, Claims regression testing & product configuration
Concentrix Daksh Services India Pvt. Ltd.
07.2006 - 04.2023
MBA - Healthcare Management
MU
B.SC - Mathematics (Hons.)
MU
12th -
Sainik School Tilaiya
10th -
Sainik School Tilaiya