Sourabh More

Benefits Implementation & Configuration Specialist.

• Led end-to-end Benefits Implementation projects, including planning, system configuration, testing, training, and post-implementation support.
• Collaborated with business users to gather and document detailed requirements, creating functional specifications for scalable solutions in healthcare, specifically for ANOC (Annual Notice of Change) and EOC (Evidence of Coverage) benefits configurations.
• Analyzed current workflows to identify areas for automation and improvement, enhancing operational efficiency and accuracy in benefits administration.
• Configured and customized Benefits modules based on business needs, ensuring compliance with healthcare regulations, and optimizing time and attendance tracking, scheduling, and labor management.
• Led product configuration for healthcare solutions, focusing on benefits design, claims processing, and document generation (ANOC/EOC).
• Integrated Benefits Applications with existing systems to ensure seamless data flow and reporting capabilities.
• Conducted thorough testing (BAT/UAT) to ensure system alignment with business needs, regulatory standards, and performance goals.
• Developed user guides, training materials, and conducted training sessions to support a smooth transition and high user adoption.
• Collaborated with cross-functional teams to deliver user-friendly solutions, addressing both technical and business requirements.
• Managed post-implementation support, troubleshooting issues, and gathering customer feedback to enhance system performance and user satisfaction.
• Leveraged Agile methodologies to streamline project delivery, reducing timelines by 30% and improving stakeholder collaboration.

• Gathered and documented business requirements, analyzing processes to ensure alignment with market needs and regulatory standards.
• Partnered with product development and testing teams to design, develop, and deliver scalable solutions ensuring functionality and performance.
• Developed an online configuration knowledge base to support system functionality, providing application overviews and best practices.
• Collaborated with healthcare providers and payers to design and configure Value-Based Care plans that met client needs, aligning product features with risk-sharing arrangements and quality improvement initiatives.
• Demonstrated expertise in product solutions, including performance-based contracts, value based care coordination, and risk adjustment.
• Achieved a 30% reduction in project delivery time by implementing Agile methodologies and focusing on stakeholder management and process improvement.
• Conducted business acceptance testing (BAT) to validate system functionality against requirements.
• Collaborated with stakeholders to design and configure plans, aligning features with business objectives and quality improvement goals.
• Elicited, documented, and analyzed business requirements from stakeholders, ensuring alignment with project goals and objectives.

• Elicited, documented, and analyzed business requirements from key stakeholders, including business users, clients, and subject matter experts, ensuring alignment with organizational objectives.
• Evaluated and optimized existing business processes related to Electronic Data Interchange (EDI) systems, identifying improvement opportunities to streamline operations and increase efficiency.
• Created and maintained detailed Business Requirement Documents (BRDs), functional specifications, use cases, process flows, and other project documentation, ensuring clarity and consistency throughout project lifecycle.
• Analyzed complex data sets, identifying trends and patterns to provide actionable insights that drove strategic decision-making and enhanced business value in healthcare and EDI processes.
• Collaborated with technical teams and architects to design effective EDI solutions that aligned with business needs and the organization's overall strategy, ensuring seamless integration and functionality.
• Worked closely with Project Managers and cross-functional teams to assess project risks, identifying potential impacts and proposing mitigation strategies to minimize disruptions and ensure successful delivery.
• Supported the testing process by defining test scenarios, conducting User Acceptance Testing (UAT), and ensuring that the solution met defined business requirements and quality standards.
• Managed changes in project scope by performing impact analysis and documenting modifications, ensuring clear communication with stakeholders and minimizing project delays.
• Contributed to thought leadership by publishing content aligned with domain and technical trends, driving innovation and positioning the organization as an industry leader.
• Established strong relationships with senior stakeholders, fostering collaboration and improving business opportunities within the healthcare and EDI sectors.
• Provided strategic guidance to senior leadership on business operations, EDI processes, and system optimization to drive operational efficiency and improve service delivery.

• Delivered Expert Support for EDI transactions in the healthcare industry, including 837P and 837I claims, 835 remittances, 270/271 eligibility files, 277CA, 999, 997 reports, and other key EDI files.
• Validated data and updated client profiles for eligibility and enrollment, ensuring accurate and timely processing of medical claims.
• Assisted providers and billing companies in verifying patient eligibility and processing medical claims, contributing to efficient operations and accurate reimbursements.
• Applied extensive knowledge of HIPAA regulations within the Payer and Provider space to ensure secure handling of Protected Health Information (PHI) and maintain compliance with healthcare privacy standards.
• Worked with healthcare providers, payers, and vendors to ensure HIPAA-compliant practices in the exchange of EDI transactions.

Client & Escalation Management

• Effectively managed client escalations and ensured high levels of customer satisfaction by addressing concerns promptly and professionally.
• Improved response time to escalations by 72%, significantly reducing issue backlogs and improving client satisfaction.
• Focused on client retention and product utilization, consistently exceeding service-level goals.

Process Optimization & Performance Metrics

• Resolved 95% of customer inquiries within assigned timelines, ensuring high-quality service and client retention.
• Re-engineered customer care processes, resulting in a 4.2% increase in customer satisfaction and more streamlined operations.
• Leveraged ServiceNow for ticket management, troubleshooting, and tracking, ensuring all client issues were addressed effectively and efficiently.