Sandeep Kushwaha
New Delhi
Summary
Accomplished Senior Associate with a proven track record at Optum Global, specializing in process enhancement and analytical thinking. Excelled in reducing account receivables and mentoring teams, demonstrating exceptional MS-Office and team supervision skills. Achieved significant improvements in claims processing efficiency and accuracy, leveraging expertise in business operations and performance monitoring.
Overview
6
6
years of professional experience
Work History
Senior Associate
Optum Global (India) solution India PVT. LTD.
New Delhi
04.2021 - Current
- Conducted thorough investigations on outstanding accounts receivables by calling insurance companies on behalf of hospitals, effectively addressing denials.
- Executed prompt transfer of outstanding balances to patients without adequate insurance coverage
- Analyzed accounts receivable data to identify and comprehend underpayment trends, days in A/R, and top denial reasons.
- Utilized appropriate codes for documenting reasons for denials and underpayments, ensuring accurate and comprehensive information.
- Tracked unpaid claims, and diligently identified underpaid and submitted claims, rectifying any discrepancies through precise documentation.
- Demonstrated expertise in the AR process by documenting and effectively educating the team.
- Collaborated with business analysts to develop comprehensive business and technical requirements for claims denial management.
- Managed high-priority claims in a time-sensitive manner, resulting in expedited resolution, and satisfied clients.
- Contributed to the development of departmental guidelines and procedures, ensuring a consistent approach to claims handling across the organization.
- Analyzed trends within the assigned portfolio to proactively address common issues and improve overall team performance.
- Trained new Claims Associates on company policies and procedures, contributing to their rapid integration into the team.
- Maintained up-to-date knowledge of industry regulations and best practices, ensuring compliance throughout the claims process.
- Examined reports, accounts, and evidence to determine the integrity and accuracy of the information.
- Worked productively in a fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Maintained a strong knowledge of basic medical terminology to better understand services and procedures.
- Reviewed outstanding requests, and redirected workloads to complete projects on time.
- Achieved reduction in outstanding debt by resubmitting edited or denied claims.
- Maintained responsibility for all inquiries, concerns and complaints, resolving matters effectively and to satisfaction of customers.
- Participated in credit and collections activities.
- Assisted with set up for social events and food deliveries.
- Maintained positive working relationship with fellow staff and management.
- Resolved customer inquiries in a timely manner while adhering to service level agreements.
- Managed team resources, including assigning tasks, monitoring progress, and ensuring deadlines were met.
- Analyzed data and created reports for senior management.
- Provided direction and guidance to junior associates on complex tasks.
- Reserved and managed meeting room availability.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Completed day-to-day duties accurately and efficiently.
- Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Recognized by management for providing exceptional customer service.
- Utilized various software and tools to streamline processes and optimize performance.
Process Associate
Genpact
02.2019 - 04.2021
- Process adjudication claims and resolve for payment.
- Knowledge in handling authorization, COB, duplicate, pricing, and corrected claims processes.
- Knowledge of healthcare insurance policy concepts, including in-network and out-of-network providers, deductible, coinsurance, co-pay, out-of-pocket maximum, and exclusions.
- Follows up on submitted claims.
- Monitors unpaid claims.
- Identify underpaid and non-billed claims with appropriate corrections and documentation.
- Conducted quality assurance checks on completed work, ensuring accuracy and compliance with established guidelines.
- Handled high volumes of incoming work requests professionally, while maintaining excellent organization.
- Independent problem solver who took the initiative in researching solutions without needing excessive supervision.
- Increased processing speed by mastering software tools and utilizing keyboard shortcuts efficiently.
- Reduced errors in data entry by maintaining strict attention to detail and thoroughness.
- Implemented organizational strategies to maintain a clean, efficient workspace.
- Managed multiple tasks simultaneously, ensuring the timely completion of all assignments.
- Communicated effectively with colleagues and supervisors to resolve issues promptly and accurately.
- Adhered to all deadlines, managing time effectively to complete tasks within designated timeframes.
- Participated in regular team meetings, contributing valuable insights toward process enhancements.
- Maintained high levels of data confidentiality through adherence to company policies and procedures.
- Conducted training and applied change management to achieve desired outcomes.
Education
Bachelor of Commerce - Commerce
Swami Shraddhanand College, University of Delhi
New Delhi, India06.2018
Skills
- Process Enhancement
- Analytical Thinking
- Report Preparation
- Performance Monitoring
- Knowledge of Business Operations
- MS-Office Package
- Performance monitoring
- Training and mentoring
- Timeline estimates
- Team supervision
Languages
Native, Native
Languages
Hindi
First Language
English
Advanced (C1)
C1
Timeline
Senior Associate
Optum Global (India) solution India PVT. LTD.
04.2021 - Current
Process Associate
Genpact
02.2019 - 04.2021
Bachelor of Commerce - Commerce
Swami Shraddhanand College, University of Delhi
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