Vigneshprabhu J
Claims - US Healthcare
Coimbatore
Summary
Talent Team Leader experienced and dedicated to enhancing employee satisfaction and business success. Have over 10+ years of experience in the US healthcare system and am well-versed in Provider Enrollment and Claims Adjudication. Keeping an eye on the new process changes, CMS transmittals, and the automation process. Expertise in member benefit and provider agreements, manual pricing techniques based on CMS, and Claims Workflow regulations; in-depth knowledge of government LOBs' end-to-end business operations (Medicare, Medicaid, and Duals). Diplomatic and friendly with proven commitment to employee training. Hardworking team player bringing necessary experience and knowledge to tackle any operational demand.
Overview
10
10
years of professional experience
3
3
years of post-secondary education
1
1
Certification
Work History
Team Leader
Cognizant Technology Solutions
12.2017 - Current
- Oversaw supervision of 100+ team members for rollout of Medicare, Medicaid, and Duals programs.
- Led team and motivated them to meet project targets and deliverables 99% of time.
- Part of 3 new project implementations of Commercial, Dual & Medicaid programs.
- Implemented process improvement ideas like pricing macros, SQL queries.
- Increased the AA% up to 4%–6% while working on the optimization project with the Facets configuration team.
- Worked together with the customer and the offshore team to identify areas for process improvement, including the Auto Adjudicate Rate, Accuracy / SLA metrics.
- In order to address pricing-related concerns in manual adjudication, the MIS team implemented VBA macros
- Made recommendations for the team's use in solving the problem.
- Working together with the project's numerous stakeholders, such as the business team, development team, and support team, to ensure successful implementation.
- For the successful execution of projects, interfaced and communicated with different stakeholders (Operations, Systems Integration, QEA, etc.)
HC & Insurance Ops Sr. Rep
NTT Data Solutions
02.2014 - 11.2017
- Trained newly hired employees on company policies and procedures regarding diverse situations.
- Answered questions quickly via email or return phone call within -hour period.
- Identified the production improvement area.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Educated staff on organizational mission and goals to help employees achieve success.
- Maintained database systems to track and analyze operational data.
- Developed effective improvement plans in alignment with goals and specifications.
- Conducted regular reviews of operations and identified areas for improvement.
- Conducted regular reviews of operations and identified areas for improvement.
- Communicated KPIs outlined in annual plan to inform employees of expectations and deliverables.
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
Education
Bachelor of Science - Computer Science
Dr.SNS Rajalakshmi College of Arts & Science
Coimbatore 04.2010 - 04.2013
Skills
Ability to work in pressure
undefinedAdditional Information
Well Knowledge in SQL Server DB
Certification
SIX SIGMA GREEN BELT Training - Apr,2017
Timeline
Team Leader
Cognizant Technology Solutions
12.2017 - Current
SIX SIGMA GREEN BELT Training - Apr,2017
04-2017
HC & Insurance Ops Sr. Rep
NTT Data Solutions
02.2014 - 11.2017
Bachelor of Science - Computer Science
Dr.SNS Rajalakshmi College of Arts & Science
04.2010 - 04.2013
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