Associate Director
United Health Group
Total years of experience :0 years, 0 Months
Medicare and Commercial Providers & Payers, overseeing back end process transitions and transactions,
streamlining and strengthening existing operations for business efficiency, identifying inefficient processes and
implementing reliable and cost-effective solutions to improve quality and ensure on-time service delivery of
support deliverables.
PROFFESIONAL HIGHLIGHTS
Initiated reengineering assignments to improve quality and production targets every quarter for both in-house and
remote teams.
Involved in transitioning outsourced projects to in-house which resulted in annual savings $2.5M
Achieved 40% productivity savings by introduction on-boarding program for new hires that makes them production
ready in 4 weeks from an earlier cycle of 12 weeks.
Skillfully transitioned and stabilized businesses across off-shore teams from 4- 200+ fte expansion within a span of
12-15 months of due diligence and solution identification.
Implemented quality control processes which resulted in 15% increase in appeals case closure rates and reduced
appeals escalations by 40%.
SKILLS
Insurance Claims Project Management Member Enrollment Services
Workforce Management Claims Inventory Management Provider Credentialing
Business Development Performance improvement Staffing & Resource Management
Transition Management Quality assurance and control Stakeholder Management
Delivery Management Budgeting and forecasting Cost reduction strategies
Capture the tactical and strategic goals that provide traceability through the organization and are mapped to metrics
that provide ongoing governance.
Assisting and overseeing monthly capacity and workforce planning for entire operations.
Describe the primary business functions of the enterprise and distinguish between customer, business execution and
business management functions.
Collaborating with business stakeholders and delivering high quality service.
Handling entire administrative and critical issues to ensure daily operational tasks are completed. Closely interact
work with domestic finance and administrative teams for smooth business transactions
Implement business strategies, core and support processes that surpass functional and organizational boundaries in
terms of agreed SLAs.
Identify and closely monitor business processes and external systems that interact with the business. Describe which
people, resources and controls are involved in the processes.
Capture the relationships among roles, capabilities and business units
Supervised a team of 7 front line managers and 220 associates across multiple business processes.
Established operational objectives and work plans and delegated assignments to subordinate managers.
Spearhead on-time delivery of support deliverables with 99% quality.
Managed projects while ensuring reliable and effective operational flow of processes by identifying gaps by
reducing discrepancies.
Spearheaded the development of the first Program Management Office, defined project management process and
managed multiple projects for quality productivity.
Effectively used Lean and Six Sigma methodologies to those projects which required quality enhancements.
Credited for well defined performance management and effectively allocated team members to constantly deliver
against set SLA’s and KPI’s. Encouraged high performance with necessary trainings and rewards on a monthly
basis.
Proven skills in cross train team members on various processes to ensure effective utilization of resources across
the team in order to maximize performance efficiencies.
Tracking monthly budget for effective capacity allocation using actual vs. forecasted projections.
Developed and implemented Business Impact Analysis (BIA) for all line of business as part of Business Continuity
plan (BCP) development.
Specialized in workforce management and maintained TAT's & SLA's across projects.
Transitions & PI (Process Improvement)
Leading and managing the outsourcing of business transition projects for improving the cost savings and Process
Monitor & Control processes to ensure 100% accuracy and timeliness.
Identifying and implementing opportunities for business process improvements that result in a better client
experience and operations optimization. Achieved close to 3-5 % FTE savings annually.
Developed onsite Knowledge Transfer plans and prepared Project Plan with well-defined stage boundaries for
achieving business goals within set timelines
Prepared SOPs (Standard Operating Procedures) and MOU’s for process documentation.
Efficiency of stakeholders through Managed services module and produced weekly dashboards for continuous
communication updates with key Stakeholders.
Scheduled regular client interactions and ensured proper review gates to sign off.
Defined SLAs and OLAs for benchmarking and monitoring progress.
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Knowledge of insurance claims and settlement terms and conditions
Strong knowledge of claims systems, claims guidelines, and claims processing methods
Excellent analytical, and error-detection skills
Remarkable computer, and written and verbal communication skills
Answered emails, letters, and phone calls and handled filing, photocopying, and faxing
CERTIFICATION & EXECUTION PRINCE2 Foundation and Practitioner (2016), Certified by AXELOS Data Science, Python 3.6 programming training and certification Certified Lean Six Sigma Green Belt ISO 9001:2008 Quality Management System Business Applications- CRM ( Salesforce ), SharePoint, ERP Enterprise