Sunita K
Subject Matter Expert
Bengaluru
Summary
Accomplished Subject Matter Expert with over a decade of experience in healthcare operations, poised to transition into a Team Lead role. Proven track record of leadership through successful training of more than 50 associates, adept management of cross-functional collaborations, and consistent drive for quality improvements. Recognized for mentoring peers, optimizing workflows, and maintaining impeccable quality standards. Eager to leverage extensive people management skills and process expertise to lead and inspire high-performing teams toward achieving organizational goals.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Subject Matter Expert |Claim Benefit Testing
Carelon Health Solutions
01.2021 - Current
- Allocated and managed tasks for testing and membership teams, ensuring optimal resource utilization.
- Maintained comprehensive trackers for inventory, avoiding shortages, and ensuring efficient workflow.
- Supporting a team of 30 members across three different locations to deliver EBA testing requirements, I provided assistance to individuals with questions that arise regarding policies, procedures, and processes.
- Upskilled the team on the most critical reviews, providing updates on policies and processes.
- Prepared a quality plan with observations and remediation on a monthly basis, and provided automation possibilities to avoid repeated defects.
- Conducted a session with the processor for the 5Y analysis, including the root cause, corrective actions, and preventive actions for each defect.
- Conducted error review sessions, PKTs, and refresher sessions on a weekly basis.
- Initiated activities like quality tutorials and a review of the champion league to improve the accuracy of the team.
- Coordinated with managers to ensure that inventory is closed within TAT, and maintaining the SLAs.
- Updating and publishing team performance, quality, and production dashboards.
- Resolving the queries submitted in SME logs, and approving the issue logs to submit to upstream.
- Responsible for the team's daily, weekly, and monthly targets in terms of productivity and accuracy.
- Collaborate with business partners to help address identified issues related to claims processes and procedures.
- Handled escalations from business partners and other operations, and provided appropriate responses with solutions.
Process Trainer & SME |PDM
Cognizant Technology Solutions
01.2017 - 01.2021
- Managed provider credentialing, contract terms, and network configuration using TriZetto FACETS, CPF & HCPM.
- Maintained and regularly update provider directories, ensuring that members had access to current and accurate information about In-network providers.
- Served as the primary point of contact for onshore teams, clients, and stakeholders for policy and procedure discussions
Process Executive |Order Management|
Fulcrum Global Info Services
2016 - 01.2017
- Ensured compliance with the U.S. Export laws and regulations in shipment documentation.
- Managed shipping documentation (SAP GTS) and tracked shipments to prevent regulatory breaches.
- Prepared error-free documentation, enhancing operational efficiency, and client satisfaction.
Claim Processing Executive | Billing & Reconciliation |
Hinduja Global Solutions
2013 - 2016
- Managed pre-adjudication, adjudication, and post-adjudication functions.
- Trained and mentored junior team members, fostering skill development.
- Ensured accurate and timely quality reporting to supervisors.
Education
Master of Science - Chemistry
Kuvempu University
05-2017
Bachelor of Science - Life Science
Dharwad University
05-2013
Skills
❖ Team Mentorship & Coaching
❖ Work Allocation & Capacity Planning
❖ Quality Assurance Programs
❖ Team Leadership & Training
❖ Process Improvement & Stakeholder Communication
❖Healthcare Tools: FACETS, WGS Platform, HCPM, ETQS, RUMBA
❖Project Management: Jira Enterprise, Jira EWM
Certification
FACET Certification: Scored 95% in Train-the-Trainer Course
Awards
- Received Innovation award for proving and successfully Implementing PC vs SOT macro
- Got Best Expertise award twice for fulfilling SME responsibilities and maintaining Team's accuracy.
- Prepared 4 Job aids and received the Impact award from Onshore Partners.
- Contributed to the implementation of SmartOps within the SPIDER process and recommended key enhancements to improve overall efficiency and increase the success ratio of Smartops
Timeline
Subject Matter Expert |Claim Benefit Testing
Carelon Health Solutions
01.2021 - Current
Process Trainer & SME |PDM
Cognizant Technology Solutions
01.2017 - 01.2021
Process Executive |Order Management|
Fulcrum Global Info Services
2016 - 01.2017
Claim Processing Executive | Billing & Reconciliation |
Hinduja Global Solutions
2013 - 2016
Master of Science - Chemistry
Kuvempu University
Bachelor of Science - Life Science
Dharwad University
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