Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Core Competencies
Professional Snapshot
Timeline
Generic
Sanjeev Kumar

Sanjeev Kumar

Noida

Summary

Dynamic professional with extensive experience at EXL Service, excelling in performance management and quality assurance. Proven track record in leading teams to achieve operational excellence, driving process improvements, and enhancing client relationships. Recognized for implementing innovative solutions that increased efficiency and reduced handling time, while fostering a collaborative work environment.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Leas Assistant Manager

EXL Service
Noida
10.2021 - Current
  • Experience of handling Medical Claim data validation, denials, Payment, Rejects & adjudication part for Worker’s Compensation Claim, US P&C auto insurance and life claims
  • Managing 16 associate’s performance.
  • Preparing Weekly and Monthly performance dashboards and review with Onshore Partners
  • Spearheading the SLA management, People Management, Attrition Management, Performance Management for major insurance Payer.
  • Ran various projects to interrelate the different business units to Improve the efficiency and customer experience & able to close 2 DMAIC Accuracy Improvement Project with client signed-off
  • SLA/KPI reporting to internal & external stakeholders
  • Manage goals, performance appraisal & Career path for Team
  • Publish monthly contractual reports to Client
  • Opportunity identification of new business & expansion within Existing business
  • Having life Claims experience also, handling policy admin services.
  • Also managing the Voice process for Life Claims

Quality Compliance Analyst

EXL Service
Noida
03.2015 - 09.2021
  • Team handling, training, audit, feedback and production and quality within defined SLA.
  • Team support, assistance and all kind of process related approvals to team.
  • Calibration with Operation team and client as Well.
  • Perform complex claims analysis and audit activities to identify trends, determine root cause of payment inaccuracies, and to recommend / implement process and systems improvements.
  • The incumbent will actively analysis on potential for provider and vendors as well as various internal divisions to ensure that potential recovery opportunities are appropriately identified by fixing the denied/rejected claims.
  • Interacting with client interaction over the call and on email.
  • Publishing process health, production, and quality and SLA/STA and all operations reports.
  • Providing coaching to team members.
  • Communicate with client with special handling of non-routine situation.
  • Monitor & reporting on standards & performance targets to client and management
  • Implement new initiatives.
  • Praise team members and creates a positive working environment.
  • Providing prompt and accurate information of individual performance to seniors.
  • Prepare daily workloads for team & co-coordinating the daily allocation of work.
  • Supplied row material data to supervisor for Making P4p, Incentive plan and Dashboard.
  • With Process Excellence and automation team developed automated work allocation tool and Average handling time tracker

Associate

EXL Service
Noida
01.2012 - 03.2015
  • Handling WC claims in order to payment and denial.
  • To review patient information as his medical document provided by Case Adjuster in order to correct payment or denial.
  • Closely work with Case adjuster for pending claims in order to close claims timely.
  • Create appeal due to incorrect denial and initiate New Claims.
  • Work on interest claims.
  • Review duplicate payment in order to prevent duplicate payment.
  • Submit NY C8 form to prevent penalty from NY WC board and post the note why claim is denied.
  • Works on CMS-1500, UB hospital bills, Dental Bills, Interpreter bills and pharmacy bills.
  • Review the service code and check provider submitted the claims as per the services.
  • To check Provider TAX ID, if Provider submitted incorrect Id then check with provider via case adjuster.
  • I have created my own tool in excel format with the help of Macros and Visual basis coding. Which is helpful for enhance Production, quality and reduce AHT
  • Reviewed and updated Standard operating procedures.
  • Stabilized client reporting and dashboards. With help of Process Excellence and automation team, automated client reports and dashboards.
  • Implemented best practices within the process to increase efficiency and to improve customer service.
  • Awarded 6 times for performance and collaboration through exclusive client recommendation.
  • Playing crucial role in quality. I have created multiple trackers that meets our client quality.
  • Submitted 40+ process improvement ideas towards the growth of the process.

Education

Bachelor of Arts -

HPU Shimla

10+2 -

HPBOSE Dharmshala

Skills

  • Performance management
  • Project management
  • Coaching and mentoring
  • Problem solving
  • Quality assurance
  • Operations management
  • Effective leadership
  • Problem-solving
  • Employee engagement
  • Effective communication
  • Client relationship management
  • Process improvement
  • Team leadership

Certification

  • HIPAA Certified
  • Intro 320 certification, 08/01/18
  • Yellow Belt certified
  • Green belt certified

Accomplishments

  • Superstar award for delivering the client task timely.
  • Royal Champ Award 5 times while working as associate and also 4 Quality Champ awards.
  • When I got promoted as an Assistant Manager, I got an opportunity to set new quality function that was successfully done within 6 months and run the process smoothly.
  • I got 3 times best QCA award out of them two awards were nominated by the client.
  • I have setup quality audit tool successfully for many of the client areas within the organization with the help of technology team.
  • Rewarded with service excellence awards many times by senior leadership.

Core Competencies

  • Quality Excellence, Having 8 years of extensive experience in quality excellence as quality compliance analyst and assistant manager. I have setup new quality function when I got promoted as Lead Assistant (LAM) and also fixed a process which was bleeding with accuracy was not met since two years. I moved there and shared my expertise there with leads and fixed the process.
  • Transition Management, Successfully transitioned 03 projects. Preparation of SOP, documents, interacting with stakeholders to determine the need of the business. Coordinating with IT, HR, Admin to have the people on board on time and sharing the update with the owners.
  • Operations Management, Project revenue forecast & planning, SLA’s, Absenteeism & attrition. Discussing strategies and customer issues logged with the client in the weekly conference call and issue action items around them. Setting up targets, SOP & SLA, setting and maintaining CTQs targets and involved in planning for the process.
  • Process Management, Monitoring the overall functioning of processes, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level. Conducting internal process audits & process reviews for ensuring strict adherence to the process parameters/systems as per defined guidelines.

Professional Snapshot

A result-oriented professional with 15+ years of experience in BPO Operations, Transitions, People Management and Client relationship management. Hands on experience in executing Business Continuity Plans, Transitioning & Implementation. Strong experience in end to end projects in Revenue Cycle Management, SLA’s, Medical billing, US P&C and Life claims.

Timeline

Leas Assistant Manager

EXL Service
10.2021 - Current

Quality Compliance Analyst

EXL Service
03.2015 - 09.2021

Associate

EXL Service
01.2012 - 03.2015

Bachelor of Arts -

HPU Shimla

10+2 -

HPBOSE Dharmshala

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Sanjeev Kumar