SHEKHAR BHANUDAS DESHMUKH
Pune
Summary
Dedicated Healthcare Operations Specialist with over 9 years of experience in medical insurance, back-office management, and customer relations. Proven track record in streamlining insurance eligibility verification, claims processing, and process auditing within the healthcare domain. Expert at resolving complex customer disputes with empathy while maintaining high-performance standards in high-pressure environments.
Overview
10
10
years of professional experience
Work History
Customer Service Representative
Evolent Health
Pune
12.2021 - Current
- Customer Service: Provided exceptional customer service to clients, ensuring quality standards and conducting customer satisfaction evaluations that enhanced service ratings.
- Streamlined cross-functional communication by managing complex Jira ticketing workflows for customer appeals, prior authorizations, and grievances, ensuring 100% of cases were routed to the correct departments for timely resolution.
- Insurance Coordination: Verified patient insurance eligibility and coverage details to ensure seamless healthcare delivery.
- Claims Management: Investigated insurance claim denials and managed the appeals process to recover outstanding payment.
- Conflict Resolution: Managed high-stress interactions and resolved complex disputes while maintaining strict professional protocols.
- Mentorship: Spearheaded the training of new hires on healthcare-specific customer service best practices and medical terminology.
- Worked as a self-driven, hardworking team player focused on meeting deadlines and delivering detail-oriented results.
Executive - Back-office (Health Insurance Specialist)
Credence Resource Management Pvt Ltd
Pune
03.2017 - 12.2021
- Streamlined billing workflows by auditing patient documentation and claim submissions, proactively resolving bottlenecks in the billing cycle to improve overall financial performance.
- Process Auditing: Conducted comprehensive data collection and analysis to identify operational gaps and share audit results with management.
- Efficiency Improvement: Streamlined back-office workflows by implementing digital document management systems, significantly reducing manual tasks.
- Patient Advocacy: Educated patients regarding their medical benefits and maintained accurate, up-to-date patient databases.
Customer Service Associate (Flipkart Process)
Concentrix
Pune
06.2016 - 11.2016
- Service Excellence: Provided expeditious solutions for emergency queries, restoring client confidence through professional problem-solving.
- Issue Resolution: Managed escalated customer complaints and queries related to high-volume e-commerce operations.
Education
Bachelor of Computer Science -
Pune University
PuneHSC - Science
Aurangabad University
SSC -
Pune University
PuneSkills
- Insurance Eligibility Verification
- Claims Denial Management
- Process Auditing
- Data Analysis & Collation
- Database Management
- Dispute Resolution
- Team Training
- Professional Communication
- Reporting & Consolidation
- MS Office and Excel
Hobbies and Interests
- Trekking
- Cricket
- Interaction with people
Technical Skills
- Database Management
- Reporting & Consolidation
- MS Office & Excel
Timeline
Customer Service Representative
Evolent Health
12.2021 - Current
Executive - Back-office (Health Insurance Specialist)
Credence Resource Management Pvt Ltd
03.2017 - 12.2021
Customer Service Associate (Flipkart Process)
Concentrix
06.2016 - 11.2016
Bachelor of Computer Science -
Pune University
HSC - Science
Aurangabad University
SSC -
Pune University