Shivam Khandagale

Enthusiastic professional with a background spent processing multi-state and global payrolls. A hardworking Payroll Specialist focused on maintaining company policies and procedures while promoting a vast knowledge of payroll and leave administration.

Motivated Senior Claims Adjuster committed to diligently investigating, evaluating and negotiating health insurance claims for policyholders. Adept at training and supporting new adjusters. Trained and knowledgeable in all state, federal and local laws. Skilled in recognizing potential fraudulent claims.

• Wipro, Subject Matter Expert, Working with Wipro in a payroll process as a subject matter expert for Leave of absence (LOA) team.
• Updating the leave calendar on workday as per the employee request.
• Applying the elimination period on short term disability(STD) and family medical leave (FMLA).
• If any leave is in denied status checking it with UNUM team and get the clarification and provide the resolution to the employee through HRX ticket.
• Resolving any queries submitted by the employee regarding leave updates on HRX assist and provide the resolution to the employee.
• Working for the client on payment of their employees who are on leave e.g. STD leave, Sick leave, Maternity leave, Military leave, etc. Issuing Off-cycle payments to those employees as per the request or as per the leave updates.
• Updating elimination period on the STD leave as per the request and SOP. Processing on-cycle payments, retro payments, manual payments and military payments.
• Creating EIB for specific payments and loading those on workday as per the pay cycle and request from client. Working on ESPP refunds and loading those refunds via EIB on monthly basis by comparing with the overpayments.
• Researching on overpayments if any and creating a breakdown of the payment and filling the overpayment form and sending it to the overpayment team.
• Making sure team is completing their target and meeting the quality on daily basis by raising rebuttals and discussions with QA team. Making sure to meet the SLA by driving team’s performance.
• Raising internal as well as external rebuttals if any and making sure the revised scores are updated in power BI. Taking huddles for error discussion and giving proper instructions and feedback to the team for maintaining the quality.
• Attending client calls on error discussions and any update related to the processing. Getting any doubts or queries resolved from client over teams or email. If any pathway update required in client sheet or pathway informing same to the client and getting it updated.
• Preparing RCA for the low performer and creating an action plan with the help of supervisor. Doing internal live audits so that we can get those errors rectified on real time basis so that unnecessary errors can be avoided. Providing complete Support to any new team member from start to end. Making sure that new team member are meeting their production target and quality

• Accenture : Transactions Processing Sr. Associate
• Worked as a “Transactions Processing Sr. Associate” in claims adjudication for US health insurance process.
• Check if the claim is valid and there is no discrepancy. Check if there are any duplicate claims for each member. If a duplicate claim found then check for the reason i.e. human error or mechanical error.
• Giving update to the team internally and solving doubts. In central claims, I was working as a claims processor ad adjudicator. Central claim’s work is based on an emulator that is called WGS.
• Finalizing a claim and making sure, we are paying the claim correctly. Verifying all the plan benefits for each year. Verifying member details, whether member is active for the plan. If any claim is processed incorrectly, we have to adjust the claim according to the edits present on the claim.
• There are different types of edits and as per edits we have different workflow for each edit. After verifying member details and policy coverage details we have to check for eligibility.
• Once eligibility is verified then finalize the claim. If the claim is not eligible to payout then deny the claim as per the reason (i.e. duplicate, no authorization, not medically necessary, policy not covered etc.).
• Processing duplicate and corrected claims by ensuring if it is a true duplicate.
• After processing claims for 3 and half year I started working as business trainer and started giving training to new batches and trained 9 batches till now. Conducting refresher training as well for internal batch movement. Auditing the processed claims by the trainees before they hit the floor.
• Taking Weekly PKT for the team. Helping the team for their doubts and queries while on floor support.

• Date of Birth: 05/01/89
• Gender: Male
• Nationality: Indian