Suman Mondal

Lead Assistant Manager with proven ability to drive team collaboration and deliver results. Skilled in team leadership, project management, and strategic planning. Known for flexibility and reliability, adapting effectively to changing needs. Strong communication, problem-solving, and decision-making abilities.

• Health Insurance claim processing Medical, Hospital and Vision claims.
• Re-adjudicating the claims.
• Processing claims with quality and issuing payment to the provider using CAS tool with in TAT (Turnaround Time).
• Processing the Special handling Claims.
• Increased client satisfaction by giving 100% quality work resulting in increased work flow to organization.
• Assisting Senior manager for manpower forecasting, revenue projection & report handling.
• Proving resolution to offshore teams.
• Generating the internal reports.
• Mentoring the new joiners for the process knowledge.
• Handling investigation unit for the co-ordination of benefits.
• Handling QR (Quality Review) claims for check value more than $15K.
• Handling dedicated control numbers with client specific guidelines.
• Responsible to handle special claims with Urgent priority where TAT is 1 day.
• Outbound calls to other insurance carrier for the member’s eligibility details.
• Internal follow-up with the member and provider for the benefit details.
• Coordinating with Second look review processor team for release High $ claims, achieving assigned targets consecutively with quality.
• Handling client interaction for strategy planning and revenue forecasting.
• Handling client's escalations when requested by supervisors.
• Following up the projects & closing it within TAT.
• Handling team performance & production data.
• Designing RUMBA keyboard macro based on the team requirements.

• Won Top Gun Award for Best Performer.
• Achieved Quality award for 100% Quality Assurance for all the Parameters over 12 months consistently for year of 2016-2017.
• Achieved Wall of Fame Award for Rework Quality and Zero Stratified Error in PG level for the year of 2017.
• Achieved Quality award for maintaining Rework percentage (
• Achieved Top Performer award for the excellent performance throughout the year 2018-2019.
• Received consecutive appreciations from Client through Mail.
• Achieved Master Mind award for the business approach throughout the year 2019-2020.

• Applications: RUMBA, HRP, ASD, KANA, Claim Initialization Tool, AWP.
• Portals: CAQH, Availity, Insurance portal(KAISER, Optum, Cigna , UHC, UMR), OPR, CCI, ATV,Quick Base