Sajaya S

The project involves processing of providers request on daily basis. The requests are received from provider office/CRED team to add the provider into the Network. Based on that request we will add providers into Network as per the standard guide lines as well as states/markets regulation.

• Project Name: PCDM
• Client’s: United Health Services (UHS)

Process Methodology:

• Processing provider’s request for US Health care industry
• Ensure the processed requests are to meet the customer quality
• To validate & process the pending providers request as per the specifications
• To reviewing the customer appeals and solving the problem based on the documents.

Roles & Responsibilities:

• Customer’s escalation/Synergy/RNOP mail handling.
• Managed the day-to-day production planning based on the inventory
• Rebuttal & Discrepancy call monitoring; coaching the team based on the call feedbacks
• Taking care of all the system/applications issues.
• Maintained Productivity in various tools, Incident ticket tracking and Data modeling
• Attend client calls and provide frequent updates or feedback to the team
• Identify trends and escalate issues to external stakeholders for resolution
• Maintain professional relationships with cross-functional departments
• Oversee daily operations, manage team schedules, and assign tasks
• Implement process improvement initiatives to enhance operational efficiency
• Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.