An experienced and skilled professional in Claims Adjudication, I am seeking a challenging role in a dynamic company where my expertise in compliance audits, team management, customer relationship management, and process optimization through Scrum and Credence training can be effectively utilized. I aim to leverage my extensive knowledge and hands-on experience in compliance audits, ISO standards, and Agile methodologies to contribute to the organization's success. With excellent interpersonal, communication, and organizational skills, I am dedicated to driving quality and efficiency in claims processing and audit compliance.
Around 22.5+ years of experience in US Healthcare operations & my strengths include: With over 22.5 years of experience in Claims Adjudication within the US Healthcare domain, I bring deep expertise across medical claims, hospital claims, provider management, case installation, and claims adjudication. I possess a strong analytical acumen and comprehensive knowledge of medical terminology, Medicare, Medicaid, and Medicare Supplement programs Currently, I manage client operations across multiple US states including California, Oregon, Montana, New Mexico, Illinois, Texas, Oklahoma, and Arizona. I am a goal-driven professional with a proven track record of aligning business strategies with operational goals, delivering measurable outcomes while balancing client satisfaction and internal revenue growth. My core competencies include: Operational management with a focus on customer satisfaction and process compliance. Expertise in service delivery, quality improvement, and reporting functions. Strong problem-solving skills in addressing customer queries and complaints. Effective presentation and interpersonal communication abilities. Experience in project estimation, resource planning, and timely execution of new business initiatives. Proficiency in risk analysis, identifying potential issues, assessing impact, and implementing countermeasures. Solid business and process knowledge, including project and customer reporting. Demonstrated ability to analyse, plan, manage, motivate, and forecast challenges. Skilled in managing customer requirements and escalations through proactive engagement. Strong professional relationships across support functions and cross-functional teams. Competence in business reporting, monitoring project execution against defined plans and schedules. Additionally, I have successfully completed Six Sigma Green Belt training, further enhancing my capabilities in process optimization and quality management.
