Yogesh Semwal
Summary
Highly motivated subject matter expert with more than 10 years of corporate experience. Specialized in personal injury, MVA and workers compensation claims. I am trustworthy dependable worked on thousands of cases and thus gathered a great experience producing a very precise or customized reports which played crucial role winning case for our clients. Major strengths in problem solving, customer satisfaction, verbal and written communication, multi tasking, and time management. Improve existing processes, procedures, technical enhancements, resource requirements and stakeholder engagement procedures to align with strategic goals.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Subject Matter Expert
Elevate Services India Pvt. Ltd.
Gurugram, Haryana
2018.04 - Current
- Identify and recommended new learning, create, and update job aids in collaboration with other SMEs and with input and approval from Director, Med Legal Production.
- Analyzed business problems, identifying root causes and developing robust solutions.
- Respond to all inquires from the team members.
- Research processing issues and find resolutions.
- Conducting weekly meeting with leadership to provide consistent feedback and help update training materials.
- Ensure consistent communications and best practices.
- Maintain inventory levels to meet service level agreements.
- Piloted program that included sitting in on new hiring training to ensure no gaps in the process and training needs are met.
- Conduct weekly one on ones with team members during training process.
- Serve as point of contact when supervisor is out of the office.
- Conduct daily huddles with staff when supervisor is out of the office.
Process Coach
R1 RCM Global Pvt. Ltd.
Gurugram, Haryana
2015.06 - 2018.02
- Trained and mentored new personnel hired to fulfill various roles.
- Conducted needs assessments to identify gaps in performance and develop targeted learning solutions.
- Provided coaching and mentoring to employees.
- Coordinated training schedules across sites with supervisors and managers to optimize training initiatives and work-flow management.
- Created written tests for various types of training courses.
- Developed lesson plans, instructional materials, and written practice tests for AR Follow up and AR Denial training courses.
- Maintains patient confidentiality and strict adherence to HIPAA guidelines.
Associate
Health Watch Tele Diagnostics Pvt. Ltd.
New Delhi
2014.05 - 2015.05
- Responsible for processing of physician Medicare and Medicaid claims within set production and quality standards.
- Entering claims into the system.
- Researching and verifying information.
- Correcting errors when necessary.
- Ensuring accurate payment is made based on contract benefits.
- Determine multiple insurance and maintain data for Coordination of Benefits (COB).
AR Associate
E4E Healthcare Business Services Pvt. Ltd.
Noida, UP
2012.11 - 2013.08
- Identified errors and re-filed denied/rejected claims as they were received from billing.
- Performing outbound calls to insurance companies in the US to collect outstanding Accounts Receivables.
- Document the details of the calls made to payers in client software.
- Reprocess and appeals for incorrect denial claims.
- Verify patient eligibility and insurance company.
- Perform timely and accurate submission of claims.
- Coordinate with the team leader in following the processes.
Customer Service Representative
AMERICAN EXPRESS TRAVEL
City
1991.01 - 2002.01
- Serviced corporate clients by providing the lowest available fares on air/rail transportation, hotel, and auto rentals through effective use of computer reservation systems.
- Handled all reservations for relocation clients and VIP's
- Verified the accuracy and completeness of all travel arrangements.
- Responded to all customer issues within set time frames
- Monitored customer satisfaction levels
- Created monthly reports of all issues
- Developed improvement plans to minimize errors and write offs.
- Processed all debits and credits as necessary.
- Handled all written and verbal communications.
- Maintained client and vendor relationships.
Education
BSc in Hospitality And Catering Management - Hospitality Administration And Management
Sikkim Manipal University
Gangtok, India09.2011
High School Diploma -
Salwan School
New Delhi, India05.2008
Skills
- Legal research and analysis
- Leadership and team management
- Sound decision making
- Claim analysis and review specialist
- Problem resolution ability
- Team player with positive attitude
- Decision making
- Critical thinking
- Healthcare Claim Coding
Certification
- Certified Hospitality Management Internship Project, Connaught Hotel Delhi - 3 Months.
- Train The Trainer Certification Training - 2 Weeks.
Cooking in weekends and outdoor, Listening to bollywood music
I absolutely love cooking. I can merrily state that my kitchen is my playground in every sense! My mother has always been a wonderful cook, and I feel she is my inspiration. Honestly, I find cooking very therapeutic and look forward to planning my meals in weekends.
I take pleasure in listening to music. I listen to music almost all the time.
Additional Information
I love the outdoors and enjoy going for motorcycle riding, hiking. It is great to connect with nature, enjoy some gorgeous views and get away from the city.
It is challenging and same time adrenaline filled and so much fun. You can hear your own breath, wind on your face make you feel like you are flying. I have been to many places in India like Jaisalmer, Spiti Valley, Coorg, Uttrakhand, Leh Ladakh.
Languages
English
Hindi
Accomplishments
- Achieved Elevate Riser award for process Improvements, Proactively leading internal innovation and process change, new Tech implementation, Proactive Customer Solution, Going beyond SLAs with customers, an extraordinary contribution to Customer Experience.
- I have created service location job aid, MBA Checklist , learning opprtunity hospital clinic visit no longer require APC code, Modifier 53, 74, fun activity, quiz, the entire MBR team is following through as a result we have fewer errors in those areas and are able to provide more accurate products to our customers.
Timeline
Subject Matter Expert
Elevate Services India Pvt. Ltd.
2018.04 - Current
Process Coach
R1 RCM Global Pvt. Ltd.
2015.06 - 2018.02
Associate
Health Watch Tele Diagnostics Pvt. Ltd.
2014.05 - 2015.05
AR Associate
E4E Healthcare Business Services Pvt. Ltd.
2012.11 - 2013.08
Customer Service Representative
AMERICAN EXPRESS TRAVEL
1991.01 - 2002.01
BSc in Hospitality And Catering Management - Hospitality Administration And Management
Sikkim Manipal University
High School Diploma -
Salwan School
- Certified Hospitality Management Internship Project, Connaught Hotel Delhi - 3 Months.
- Train The Trainer Certification Training - 2 Weeks.
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