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Work Experience
Senior Business Consultant
Optum Global Advantage• November 2021 - Present
Currently associated with Enterprise Value Enhancement Project as a Senior Business Consultant. Hands-on knowledge of various domains like E2E US Healthcare, OpX, ARA & RPA Projects. Cost Reduction Expert utilized Lean and Six Sigma Techniques to identify and implement improvement opportunities Proficient in leading re-engineering, process improvement, and Operational Excellence projects
Business Consultant
Optum Global Advantage• January 2017 - November 2021
Analyzed US Healthcare claims data against applicable policies and regulations to identify potential issues (e.g., member benefits, provider contracts, billing anomalies, payment accuracy, claims processing system issues, state mandates) Developing project baselines; monitoring & controlling projects with respect to cost, resource, deployment, time over-runs, and quality compliance to ensure satisfactory execution of projects Organizing/participating in project review meetings for evaluating project progress & de-bottle-necking Understanding the business needs & identifying initiatives that will allow a business to meet their business strategic goals
Business Analyst
Optum Global Advantage• January 2013 - January 2017
Helped provide solutions to the issues to improve the quality, End-to-End Review of US Healthcare claims to give the root cause analysis. Work on Health Care Reform (HCR) & Episode of Care (EOC) related issues
Subject Matter Expert - US Healthcare
Optum Global Advantage• December 2010 - January 2013
Managed a team to ensure that they come out from the learning curve & I can bridge any knowledge gaps Driving the team in day-to-day work and making them work with effectiveness Responsible for Quality and Production targets for the team Controlling Inventory for the Team
Claims Specialist
Optum Global Advantage• November 2008 - December 2010
Manual Claim Adjudication for multiple health care specialties, places of service, benefits, and plan types. Utilize concepts related to Prior Authorization, iBAAG, contracted rates, etc. to determine on claim payment in terms of Pay, Deny, or Route. Right provider selection to ensure correct payment. Maintaining HIPPA compliance and customer confidentiality. Meet OAR & DAR Targets
Education
Maharishi Dayanand University, Rohtak (Haryana )
Business Administration, Bachelor• July 2005 - June 2008
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