Summary
Overview
Work History
Education
Skills
Accomplishments
Personal Information
Mailingaddress
Disclaimer
Timeline
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Soma Sai Kumar

Hyderabad

Summary


  • A result-oriented SME with 6+ years of work experience in health care. Specialized in Medicare, Medicaid and COB and other claims processing business division/ units including HMO Encounters and health insurance plans(HMO, PPO,EPO & POS)
  • Performed various roles which include team handling, people management, driving teams in managing daily business deliverables
  • Trained around 250 new hires on adjudication, adjustments & provider escalations for trainees across hyderabad, bangalore, gurugram and philippines locations
  • Been to philippines for business transition purpose and live support for 30 associates including Manila & Iloilo sites for 6 weeks
  • Exposure in handling client queries, providing them feasible solutions & building healthy relationships thereby achieving highest stakeholders satisfaction

Overview

6
6
years of professional experience

Work History

Subject Matter Expert

Carelon Global Solutions
11.2022 - Current
  • Handling team size of 25-30 associates and helping them in solving all process related queries to ensure continuous learning and improvement
  • Driving team to reach their individual production & quality metrics thereby achieving team wise performance goals set by the management
  • Conducting daily huddles, brainstorming sessions and SBS audits
  • Handling Onshore escalations and ensuring all emails are closed within TAT
  • Part of IDEATHON 2024 SME review panel, which includes deep dive on each submitted idea thereby either approving or rejecting based on the possibility in implementation
  • Supported Adjudication team as an acting lead between Feb 2023 to May 2023

Senior Associate

Carelon Global Solutions
10.2020 - 11.2022
  • Managed weekly OE calls and resolving issue claims with the help of onshore partners
  • Handled/ managed daily inventory reviews and daily work allocation
  • Helped team in reaching daily deliverables including self
  • Worked in automating the possible scenarios and edits which does not require Man power
  • Collaborated with cross-functional teams to drive successful completion of complex projects within deadlines.

Associate

Carelon Global Solutions
01.2019 - 10.2020
  • Claims processor- After careful investigation into each claim thereby either allowing or rejecting based on the type of policies customers opted
  • Helped team by resolving process queries
  • Trained new hires and supported in RAMP phase

Education

MBA - Finance

Sri Indu PG College
01.2021

B.COM - Computers

Badruka college of Commerce and Arts
01.2017

Skills

  • People Management
  • Business transition support
  • Cross training/new hires training
  • MS Office- Excel
  • Teamwork and collaboration
  • Idea development and brainstorming

Accomplishments

  • Received Star performer award for 2019 and many other quarterly Spot awards
  • Winner of the IDEATHON 2021 (For Idea to automate the Adjustment claims recovery inquiries)
  • Got a chance to train and support 30 associates in Philippines from Iloilo and Manila sites

Personal Information

  • Date of Birth: 02/20/1997
  • Gender: Male
  • Nationality: Indian
  • Marital Status: Unmarried
  • Languages Known : English, Telugu, Hindi.

Mailingaddress

H.no: 18-1-101/3/11A, Huppuguda, Shiva sai nagar, Hyderabad, Telangana, 500053

Disclaimer

I hereby declare that the above-mentioned details are true as per my knowledge and I bear the responsibility for the correctness of the above said details.

Timeline

Subject Matter Expert

Carelon Global Solutions
11.2022 - Current

Senior Associate

Carelon Global Solutions
10.2020 - 11.2022

Associate

Carelon Global Solutions
01.2019 - 10.2020

B.COM - Computers

Badruka college of Commerce and Arts

MBA - Finance

Sri Indu PG College

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Soma Sai Kumar