Process Executive, Senior Process Executive
Cognizant Technology Solutions Pvt Ltd
04.2021 - 4 2024
- Group claims, a leading healthcare organization, entrusted with managing the credentialing and Recredentialing processes, ensuring accuracy and compliance in provider credentialing
- As a Process Associate, adeptly oversee the credentialing process, maintaining meticulous attention to detail and regulatory requirements to uphold provider credentialing standards for Group claims
- Managed end-to-end credentialing and recredentialing processes for healthcare providers, ensuring accuracy and compliance with regulatory standards
- Conducted thorough verification of provider credentials, including licensure, education, training, and certifications, to uphold quality standards
- Collaborated with internal teams and external stakeholders to streamline credentialing processes and improve efficiency
- Acted as a liaison between healthcare providers and insurance plans, facilitating communication and resolving issues related to credentialing
- Provided training and support to team members on credentialing processes and procedures, fostering a culture of excellence and professionalism
- Collaborated with quality assurance teams to conduct audits and reviews of credentialing activities, identifying areas for improvement and implementing corrective actions
- Consistently achieved 100% production and upheld adherence to internal and external quality standards within transaction processing timelines, meeting TAT metrics effectively.
- HCSC, a prominent healthcare provider, excels in managing AT&T and Boeing processes with precision and compliance, ensuring uninterrupted access to essential healthcare coverage
- Through meticulous administration, HCSC upholds its commitment to delivering quality care and safeguarding participant well-being
- Effectively administered all aspects of AT&T and Boeing processes, including sending notifications, collecting applications, managing premium payments, handling terminations, conducting billing activities, verifying eligibility, and managing dependent coverage adjustments, ensuring compliance and seamless coverage transitions
- Providing assistance and support to AT&T and Boeing participants regarding their coverage options, rights, and obligations under AT&T and Boeing, as well as addressing inquiries, concerns, or issues related to AT&T and Boeing claims
- Diligently maintained detailed documentation and reports to ensure regulatory compliance, while prioritizing accuracy, compliance, and timeliness throughout the AT&T and Boeing process to meet participant needs and uphold regulatory standards
- Train new hires and provide ongoing development opportunities for team members to enhance skills and capabilities
- Maintain a high level of customer service by promptly addressing client inquiries, resolving issues, and fostering positive relationships
- Consistently maintained 100% production and adherence to internal and external quality standards within transaction processing timelines, including meeting TAT metrics.
