Surya AM
Kotagiri
Summary
A healthcare operations professional with over 7 years of experience in the U.S. Healthcare projects, specializing in claims adjudication and auditing within the Facets application. Expertise in claims processing, adjustment claims, Coordination of Benefits (COB), and performance-based auditing. Formerly worked at NTT Data as a Senior Associate in Transaction Quality Assurance, focusing on end-to-end claims quality audits for prepaid and performance claims.
Overview
8
8
years of professional experience
Work History
Team Lead
Sutherland Global Services
Chennai
11.2024 - Current
- Led quality assurance initiatives to enhance product reliability and compliance.
- Conducted root cause analyses on adjudicated professional and hospital claims to identify systemic errors, and reduce future denials and payment discrepancies.
- Collaborated with cross-functional teams to implement corrective actions from RCA findings, enhancing claim accuracy and audit compliance.
- Conducted regular audits of processes to ensure adherence to industry standards.
- Provided expert guidance to resolve complex inquiries from internal teams.
- Identified areas for improvement, narrowing focus for decision-makers in making necessary changes.
- Resolved escalated customer issues in a timely manner while maintaining positive relationships.
- Attended meetings with external auditors to discuss audit strategies and findings.
Senior Associate
NTT Data Global Delivery Services PVT LTD
Coimbatore
08.2022 - 08.2024
- Conduct audits on previously adjudicated claims to ensure accuracy and compliance.
- Assess quality outputs against internal and external standards to identify areas for improvement.
- Delivering superior quality as a fundamental aspect of operations.
- Understanding customer requirements to precisely meet their expectations.
- Utilizing a metrics-based approach to identify trends and patterns for ongoing staff training and continuous improvement.
- Conducted process assessments to identify areas of improvement in business operations.
Process Executive
Cognizant Technology Solutions (CTS) India PVT LTD
Coimbatore
07.2017 - 08.2022
- Investigated professional and hospital insurance claims to determine eligibility for a cash settlement, denial, or negotiation.
- Evaluate all claims and policy information.
- Analyze facets related to policy contracts, and make informed decisions on claims.
- Performing a quality audit for previously adjudicated insurance claims.
- Reviewing the system configuration test sample claims.
- Reviewed and processed insurance claims for accuracy and compliance.
Education
Bachelor of Arts - Computer Application
Kaypeeyes College of Arts And Science
Kotagiri10.2015
Skills
- Facets application
- Citrix
- Webstrat
- MHS
- Macess
- HSQMS
- MS Excel and MS Office
- Claims auditing (prepaid and performance)
- Root cause analysis and compliance
Accomplishments
- Team Award, 09/2017
- Spot Light Award, 03/2019
- Quality Award, 06/2024
Languages
- Tamil, First Language
- English, Read, Write, Speak
Additional Responsibilities
- Inventory management and Assign task ageing orderly
- Pre-auditing the High Dollar claims before check Run
- Reviewing the system configuration test sample claims
- Maintaining Team production and quality reports and need to publish monthly basis
- Managing the team and providing claim allocations on daily basis
Timeline
Team Lead
Sutherland Global Services
11.2024 - Current
Senior Associate
NTT Data Global Delivery Services PVT LTD
08.2022 - 08.2024
Process Executive
Cognizant Technology Solutions (CTS) India PVT LTD
07.2017 - 08.2022
Bachelor of Arts - Computer Application
Kaypeeyes College of Arts And Science
Similar Profiles
Marcus Yousuf JegarajMarcus Yousuf Jegaraj
NA at Sutherland Global Services, Mcafee Techmaster ServicesNA at Sutherland Global Services, Mcafee Techmaster Services
Vinayak ShindeVinayak Shinde
Manager - Global Fin & FPNA at Sutherland Global Services Pvt Ltd.Manager - Global Fin & FPNA at Sutherland Global Services Pvt Ltd.
Vaishnavi JagtapVaishnavi Jagtap
Associate at Sutherland Global ServicesAssociate at Sutherland Global Services
PRAVEENA KPRAVEENA K
Chat Support Representative at Sutherland Global ServicesChat Support Representative at Sutherland Global Services
JANANI PJANANI P
Senior Relationship Manager at Edelweiss Life Insurance Co LtdSenior Relationship Manager at Edelweiss Life Insurance Co Ltd