Summary
Overview
Work History
Education
Skills
Certification
Languages
Hobbies and Interests
Projects
Personal Information
Technical Tools
Timeline
Generic

Sandhya L. K

Bengaluru

Summary

Dedicated Claims and Quality Analyst with over 5 years of experience in healthcare and insurance claims processing, auditing, and root cause analysis. Proven ability to manage high-value claims, lead process improvements, and collaborate with cross-functional teams. Seeking to leverage my analytical and operational skills in a Claims Management Analyst role at Accenture to support intelligent insurance operations and deliver value-driven client solutions.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Quality Analyst

Carelon Global Solutions
Bengaluru
03.2023 - Current
  • Conduct end-to-end audits on high-dollar healthcare claims, ensuring compliance with policies and regulatory standards.
  • Execute quality checks across the claims lifecycle: adjudication, eligibility, benefits, and provider contracts.
  • Perform RCA and deliver feedback to examiners via review calls, reducing recurrence of audit errors.
  • Led calibration sessions and maintained QRG documentation for knowledge consistency.
  • Acted as an SME, coordinating team huddles, managing escalations, and mentoring new associates.
  • Liaised with clients and internal stakeholders to align quality objectives with operational goals.

Claims Associate

Carelon Global Solutions
Bengaluru
08.2020 - 02.2023
  • Processed Professional & Facility claims with accuracy, including Medicare, Medicaid, and ITS claims.
  • Investigated and resolved complex or aged claims within deadlines and policy constraints.
  • Applied benefit eligibility checks, adjusted claims per audit findings, and initiated RCA on anomalies.
  • Specialized in high-dollar and legacy claims; ensured compliance with payer policies and billing edits.

Technical Recruiter

Sun Technologies Pvt. Ltd.
Bengaluru
07.2019 - 06.2020
  • Managed full-cycle recruitment and conducted pre-screening of candidates for technical roles.
  • Negotiated compensation and coordinated with HR teams to fulfill business hiring goals.

Education

Bachelor of Business Administration - Finance and Accounts

St. Claret College
Bengaluru, KA
01.2019

Skills

  • Claims Processing
  • Property & Casualty Claims
  • Audit & Quality Assurance
  • Root Cause Analysis
  • Client Communication
  • Stakeholder Management
  • Team Collaboration
  • Leadership
  • MS Excel
  • SharePoint
  • CIW
  • WGS
  • Process Improvement
  • Documentation

Certification

  • Microsoft Certified – Advanced Excel, 2018
  • Soft Skills Development Program, 2017

Languages

  • English, Intermediate – International
  • Malayalam, Fluent
  • Kannada, Fluent

Hobbies and Interests

  • Reading Novels
  • Process Improvement
  • Team Mentorship

Projects

Financial Planning and Forecasting – Elyon Switchgears Pvt. Ltd., 01/01/19, 04/30/19, Analyzed working capital, forecasting models, and financial statements to evaluate the company’s financial health and planning processes.

Personal Information

  • Date of Birth: 05/16/98
  • Nationality: Indian
  • Marital Status: Single

Technical Tools

  • WGS
  • Excel
  • SharePoint
  • CIW
  • QRG Documentation
  • Audit Scorecards

Timeline

Quality Analyst

Carelon Global Solutions
03.2023 - Current

Claims Associate

Carelon Global Solutions
08.2020 - 02.2023

Technical Recruiter

Sun Technologies Pvt. Ltd.
07.2019 - 06.2020

Bachelor of Business Administration - Finance and Accounts

St. Claret College

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Sandhya L. K