Sr. Claims Associate. ( Acting SME ( Trainer ) / Team Lead )
UNITED HEALTH GROUP INFORMATION SERVICES PRIVATE LTD
Keywords
Skills
MS-Excel, MS-Access, VBA, Macro Express, Excel, People Soft, spreadsheet, SAP Recon, UNET, Data Management
Project history
08/2011
-
05/2018
Present Process: Unet - Billing
Designation : Sr. Claims Associate. ( Acting SME ( Trainer ) / Team Lead )
Company Profile: UnitedHealth Group is the most diversified health care company in the United States
and a leader worldwide in helping people live healthier lives and helping to make the health system
work better for everyone. It is one of Fortune Companies.
United Health group also have IT solutions top 500 companies in the United States. UnitedHealth
Group offers a spectrum of products and services through two operating businesses: UnitedHealthcare
and Optum.
Roles & Responsibilities:
* Allocating work to the Team.
* Maintaining SLA report and coordinating with onshore partners.
* Training new Joiners.
* Maintaining P&P and coordinating with onshore for timely update.
* Preparing and Maintaining team reports.
* Updating and sending daily reports.
* Maintained the Dashboard of the team.
* Act as a team player.
* Worked on Emails in client side mailbox and resolving issues/Queries on member headcount /
Cobra member count / Addresss/ Premiums /Commissons /Bonus and other queries in Tax reports (
5500 Schedule A reports ) raised by customers/brokers/groups /Billing Analyst's/ SAE's/ UW's.
Providing Detailed reports of Medical/ Dental / Vision reports ( Unet platform ) & Life
reports ( Facets Platform ) . Including all coverage's in PRIME platform.
* Resolving Commissions/Bonus queries to customers by coordinating with commissions/Bonus team.
* Enrolling New-Borns in member portal and verifying data in People-Soft. Member to Member
reconciliation.Retrieving policy information from BSR (Billing Structure Report )
*
Acknowledging the Renewal / termination of policy with Onshore Billing Analyst. Placing bill
on Hold to stop automatic Invoice generation in ACIS till the payment posting and update in
Simon.
*
Preparing Monthly report for yearly renewal group every month as per renewal month in Excel
using Excel skills.
* For life ( Facets ) groups information we use Business objectives and Serena for checking
Policy information on effective date and Cancellation dates respectively . IBM Personal
communications applications TSO for checking headcounts.
* Worked on Quarterly reports like SAP Recons by MS-Access Data-Base
* Worked on Monthly reports like Groups Policy Renewals, Paid-in-Advance files.
* Worked on CDIX , IBM personal Communications , TSO , ACIS , Facets ,Orbit , Simon ,
People-Soft , rsrreports ( commissions Site ) applications.
* Played an important role in Internal auditing and improved accuracy of the date processed.
* Maintaining Team production , Quality reports and Dashboard and sharing daily reports to
Senior team members and leaders. Training New Joiners, Clarifying the team queries.
* Worked on Unet platform in preparing Schedule A report which are used for Tax.
* Played an important role in internal auditing & improved accuracy of the data processed.
* Preparing Life Reports for Facets platform.
* Preparing Schedule A report for PRIME platform.
* Gathering required information from different applications and preparing Schedule A reports.
* Using BSR ( Billing Structure Report ) to retrieve the policy information like plan
information , Coverage's ( Medical , Vision , Dental & Life .etc )
* Using FACETS application to prepare the Life reports.
* Using Serena to validate the terminated date of the policy and pull Group information.
* Adding Newborns to the members portal.
* Member to Member Reconciliation.
* Using Business objects application to retrieve premiums for Life groups
* Using IBM application for policy plan year for PRIME platform
* Using Employee e-services application to retrieve the headcount.
* Using People Soft application to get the address and premiums for particular policy for Unet
and Prime platforms and commission's information for Life coverage which is Facets platform.
* Preparing monthly spreadsheet using Excel Skills.
* Running queries in MS access and Retrieving data for monthly process
* Worked on Facets platform
* Worked on ACIS platform on bills and Renewals
* Worked on SAP Recon.
* Worked on IBM Personal Communications to retrieve employee information.
* Providing the 5500 schedule A reports for customers and brokers for their Tax filing.
* Dealing with customers via Emails and ETS system.
* Used Simon to retrieve renewal and plan details.
* Used CDIX for complete plan details including sales and services details
* Used Orbit to provide the break-up of reports product-wise.
* Used orbit to provide the HPHC reports.
* Used rsrreports (commission's site) to retrieve the commissions and broker details for UNET
and PRIME PLATFORMS.
* Used Facets to know Life products, coverage's and commissions percentage and mode of plan.
* Providing COBRA members count to the Customers.
Achievements:
* Implemented a Bright Idea to run process monthly report which reduced report time to 2
minutes from few hours.
* Achieved productivity then the given target with 100% accuracy everytime.
* Achieved 100% accuracy consistently more than 5 years in a row.
* Mentored new joiners by helping them understand the process and solving their queries
* Achieved few awards Like Star , Venus Awards.
* Nominated for Service Hero in 2015.
* Consistently maintained Production & Quality above targets set by the client.
Designation : Sr. Claims Associate. ( Acting SME ( Trainer ) / Team Lead )
Company Profile: UnitedHealth Group is the most diversified health care company in the United States
and a leader worldwide in helping people live healthier lives and helping to make the health system
work better for everyone. It is one of Fortune Companies.
United Health group also have IT solutions top 500 companies in the United States. UnitedHealth
Group offers a spectrum of products and services through two operating businesses: UnitedHealthcare
and Optum.
Roles & Responsibilities:
* Allocating work to the Team.
* Maintaining SLA report and coordinating with onshore partners.
* Training new Joiners.
* Maintaining P&P and coordinating with onshore for timely update.
* Preparing and Maintaining team reports.
* Updating and sending daily reports.
* Maintained the Dashboard of the team.
* Act as a team player.
* Worked on Emails in client side mailbox and resolving issues/Queries on member headcount /
Cobra member count / Addresss/ Premiums /Commissons /Bonus and other queries in Tax reports (
5500 Schedule A reports ) raised by customers/brokers/groups /Billing Analyst's/ SAE's/ UW's.
Providing Detailed reports of Medical/ Dental / Vision reports ( Unet platform ) & Life
reports ( Facets Platform ) . Including all coverage's in PRIME platform.
* Resolving Commissions/Bonus queries to customers by coordinating with commissions/Bonus team.
* Enrolling New-Borns in member portal and verifying data in People-Soft. Member to Member
reconciliation.Retrieving policy information from BSR (Billing Structure Report )
*
Acknowledging the Renewal / termination of policy with Onshore Billing Analyst. Placing bill
on Hold to stop automatic Invoice generation in ACIS till the payment posting and update in
Simon.
*
Preparing Monthly report for yearly renewal group every month as per renewal month in Excel
using Excel skills.
* For life ( Facets ) groups information we use Business objectives and Serena for checking
Policy information on effective date and Cancellation dates respectively . IBM Personal
communications applications TSO for checking headcounts.
* Worked on Quarterly reports like SAP Recons by MS-Access Data-Base
* Worked on Monthly reports like Groups Policy Renewals, Paid-in-Advance files.
* Worked on CDIX , IBM personal Communications , TSO , ACIS , Facets ,Orbit , Simon ,
People-Soft , rsrreports ( commissions Site ) applications.
* Played an important role in Internal auditing and improved accuracy of the date processed.
* Maintaining Team production , Quality reports and Dashboard and sharing daily reports to
Senior team members and leaders. Training New Joiners, Clarifying the team queries.
* Worked on Unet platform in preparing Schedule A report which are used for Tax.
* Played an important role in internal auditing & improved accuracy of the data processed.
* Preparing Life Reports for Facets platform.
* Preparing Schedule A report for PRIME platform.
* Gathering required information from different applications and preparing Schedule A reports.
* Using BSR ( Billing Structure Report ) to retrieve the policy information like plan
information , Coverage's ( Medical , Vision , Dental & Life .etc )
* Using FACETS application to prepare the Life reports.
* Using Serena to validate the terminated date of the policy and pull Group information.
* Adding Newborns to the members portal.
* Member to Member Reconciliation.
* Using Business objects application to retrieve premiums for Life groups
* Using IBM application for policy plan year for PRIME platform
* Using Employee e-services application to retrieve the headcount.
* Using People Soft application to get the address and premiums for particular policy for Unet
and Prime platforms and commission's information for Life coverage which is Facets platform.
* Preparing monthly spreadsheet using Excel Skills.
* Running queries in MS access and Retrieving data for monthly process
* Worked on Facets platform
* Worked on ACIS platform on bills and Renewals
* Worked on SAP Recon.
* Worked on IBM Personal Communications to retrieve employee information.
* Providing the 5500 schedule A reports for customers and brokers for their Tax filing.
* Dealing with customers via Emails and ETS system.
* Used Simon to retrieve renewal and plan details.
* Used CDIX for complete plan details including sales and services details
* Used Orbit to provide the break-up of reports product-wise.
* Used orbit to provide the HPHC reports.
* Used rsrreports (commission's site) to retrieve the commissions and broker details for UNET
and PRIME PLATFORMS.
* Used Facets to know Life products, coverage's and commissions percentage and mode of plan.
* Providing COBRA members count to the Customers.
Achievements:
* Implemented a Bright Idea to run process monthly report which reduced report time to 2
minutes from few hours.
* Achieved productivity then the given target with 100% accuracy everytime.
* Achieved 100% accuracy consistently more than 5 years in a row.
* Mentored new joiners by helping them understand the process and solving their queries
* Achieved few awards Like Star , Venus Awards.
* Nominated for Service Hero in 2015.
* Consistently maintained Production & Quality above targets set by the client.
10/2008
-
06/2011
Process Associate
APOLLO HEALTH STREET PRIVATE LTD
Present Process: Child PDM (VIANT-OEC)
Designation : Process Associate.
Company Profile: Apollo Health Street, a global Healthcare services company of the Apollo group
offers Business Process Outsourcing and IT solutions and services to a global client. Now it is
merged with southern land Inc.
Roles & Responsibilities:
* Worked on Provider Data Management.Maintaining providers Demographic information,Provider
contracts and network affiliations. Assigning the network to the provider to get paid.
* Network integration & Analysis/Updation of Network Reimbursement Plan - To maintain single
source for provider reimbursement information.
* Worked on Provider Data Correction - Including Name , Address based on ancillary matching,
State, Name, Address (State) , Specialty.
* Verifying Address based on zip by validating in USPS ( United States Postal Service).Verifying
the provider details names and name changes based on SSN,EIN( Employer Identification
Number),NPI ,UPIN (Unique physician/Provider Identification Number ).Verifying NPI ( National
Provider Identifier ) in NPPES -NPI Registry (National Plan and Provider Enumeration
System).Verifying UPIN in upin.ecare.com.
* Finding National Ancillaries. Claims matching and network assigning based on provider name and
address match. Responsible for Data review, Analysis, Correction and maintenance, facilitating
the timely and accurate processing of all Physician agreements for claim payment.
* Assigning Provider to Network.
* Worked on Claims.
* Maintaining Providers Demographic information , Providers Contracts and Provider Network
Affiliations so as to create a single record of truth.
* Network integration & Analysis/Updation of Network Reimbursement Plan - To maintain single
source for provider reimbursement information
* Worked on Provider Data Correction - Including Name , Address
* Worked on Assigning network based on ancillary matching.
* Assigning Network to provider Based on State, Name, Address (State) , Specialty.
* Verifying Provider names and name changes.
* Verifying Address based on zip by validating in USPS ( United States Postal Service).
* Verifying the provider details based on SSN,EIN( Employer Identification Number),NPI ,UPIN
(Unique physician/Provider Identification Number ).
* Verifying NPI ( National Provider Identifier ) in NPPES -NPI Registry (National Plan and
Provider Enumeration System).
* Verifying UPIN in upin.ecare.com.
* Finding National Ancillaries.
* Claims matching and network assigning based on provider name and address match.
* Responsible for Data review, Analysis, Correction and maintenance, facilitating the timely and
accurate processing of all Physician agreements for claim payment.
* Trained new Joiners.
* Clearing Doubts act as mentor in the process.
Achievements:
* Took up the challenge of consistently maintaining more productivity than the given target
with 100% accuracy.
* Trained and Mentored new joiners by helping them understand the process and solving their
queries.
* Successfully handling a team of 8 associates as bay leader.
* Playes an important role in auditing & improved the accuracy of the data processed.
Designation : Process Associate.
Company Profile: Apollo Health Street, a global Healthcare services company of the Apollo group
offers Business Process Outsourcing and IT solutions and services to a global client. Now it is
merged with southern land Inc.
Roles & Responsibilities:
* Worked on Provider Data Management.Maintaining providers Demographic information,Provider
contracts and network affiliations. Assigning the network to the provider to get paid.
* Network integration & Analysis/Updation of Network Reimbursement Plan - To maintain single
source for provider reimbursement information.
* Worked on Provider Data Correction - Including Name , Address based on ancillary matching,
State, Name, Address (State) , Specialty.
* Verifying Address based on zip by validating in USPS ( United States Postal Service).Verifying
the provider details names and name changes based on SSN,EIN( Employer Identification
Number),NPI ,UPIN (Unique physician/Provider Identification Number ).Verifying NPI ( National
Provider Identifier ) in NPPES -NPI Registry (National Plan and Provider Enumeration
System).Verifying UPIN in upin.ecare.com.
* Finding National Ancillaries. Claims matching and network assigning based on provider name and
address match. Responsible for Data review, Analysis, Correction and maintenance, facilitating
the timely and accurate processing of all Physician agreements for claim payment.
* Assigning Provider to Network.
* Worked on Claims.
* Maintaining Providers Demographic information , Providers Contracts and Provider Network
Affiliations so as to create a single record of truth.
* Network integration & Analysis/Updation of Network Reimbursement Plan - To maintain single
source for provider reimbursement information
* Worked on Provider Data Correction - Including Name , Address
* Worked on Assigning network based on ancillary matching.
* Assigning Network to provider Based on State, Name, Address (State) , Specialty.
* Verifying Provider names and name changes.
* Verifying Address based on zip by validating in USPS ( United States Postal Service).
* Verifying the provider details based on SSN,EIN( Employer Identification Number),NPI ,UPIN
(Unique physician/Provider Identification Number ).
* Verifying NPI ( National Provider Identifier ) in NPPES -NPI Registry (National Plan and
Provider Enumeration System).
* Verifying UPIN in upin.ecare.com.
* Finding National Ancillaries.
* Claims matching and network assigning based on provider name and address match.
* Responsible for Data review, Analysis, Correction and maintenance, facilitating the timely and
accurate processing of all Physician agreements for claim payment.
* Trained new Joiners.
* Clearing Doubts act as mentor in the process.
Achievements:
* Took up the challenge of consistently maintaining more productivity than the given target
with 100% accuracy.
* Trained and Mentored new joiners by helping them understand the process and solving their
queries.
* Successfully handling a team of 8 associates as bay leader.
* Playes an important role in auditing & improved the accuracy of the data processed.
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