S RAJKUMAR
Coimbatore
Summary
I have over six years of experience working on US healthcare projects, and I am presently employed with NTT Data as a senior associate in transaction quality assurance for aspects claim auditing for prepaid and performance.
Five years of claim adjudication and one year of claims auditing in Facets. Additionally, I am proficient in the SQL programming language.
Overview
6
6
years of professional experience
Work History
Transaction Quality Assurance SR. Associate
NTT DATA
Coimbattore
08.2024 - Current
- Ensured precise verification of Contract percentage for Audited Prepay Claims from different clients such as various Business plans, Medicaid, Medicare, and Marketplace contracts.
- Implemented and maintained the Quality Assurance Methodology to ensure superior quality in all operational planning.
- Performed high-dollar audits for paid and denied claims with 100% accuracy to deliver optimal results.
- Developed creative solutions to address challenging issues arising from audits or other assurance services engagements.
- Provided coaching and guidance to junior staff members regarding audit techniques, as needed.
- Used strong attention to detail and knowledge of resources to manage technical issues.
- Prepared detailed reports on audit results.
Senior Process Executive
COGNIZANT TECHNALOGY SOLUTION
Coimbatore
07.2018 - 08.2024
- A claims adjudicator investigates professional insurance claims to determine if a claim is eligible for a cash settlement or if it should be denied or negotiated.
- Evaluates all claim and policy information, interviews insured clients, physicians, and attorneys, and evaluates all facts for policy contracts.
- Maintains records of benefits, resolves issues in claim processing, and performs quality audits for previously adjudicated claims.
- Accomplished service goals through efficient task prioritization and organization.
- Played a key role in driving improvements to both the state complaint project and reprocessing project through the ServiceNow application.
- Demonstrated leadership by making improvements to work processes and helping to train others.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Assisted in the development of training materials and resources.
Education
HSC -
Gandhi Kala Nilayam Higher Secondary School
01.2014
SSLC -
Gandhi Kala Nillyam Higher Secondary School
01.2012
B.Sc(Computer Science) -
Shri Nehru Maha Vidyalaya College of Arts & Science, Bharathiar University
Skills
Facets
Citrix
Service Now
Webstrat & PSI Tool
CWS tool
SQL Programming(Basic)
Personal Information
- Date of Birth: 12/05/97
- Marital Status: Single
Languages
English, Tamil (Read, Write, and Speak)
Extracurricular Activities
Volunteered in Rotary Club during under graduation Volunteered in NSS during under graduation Volunteered in NCC.
Hobbies and Interests
Playing volleyball ball & Travelling
Disclaimer
I hereby declare that the above details given by me are true to the best of my knowledge.
Languages
Tamil
First Language
English
Intermediate (B1)
B1
Timeline
Transaction Quality Assurance SR. Associate
NTT DATA
08.2024 - Current
Senior Process Executive
COGNIZANT TECHNALOGY SOLUTION
07.2018 - 08.2024
HSC -
Gandhi Kala Nilayam Higher Secondary School
SSLC -
Gandhi Kala Nillyam Higher Secondary School
B.Sc(Computer Science) -
Shri Nehru Maha Vidyalaya College of Arts & Science, Bharathiar University