SummARY

** ***** ***********, *************, ****** oriented & entrepreneurial

experience in Health Plan operations, strategy, business development &

process improvement. Successfully led and managed high profile provider

network strategy, new market entry, provider platform migration, network

management, operating model redesign and product implementations

initiatives for Commercial, Medicare and Medicaid businesses for Fortune

500 National and Regional Health Plans in US, South America, Middle East

and Asia.

PROFESSIONAL ExperienCE

Deloitte Consulting

Philadelphia, PA

Fortune 100, world's largest and most diverse Healthcare Strategy &

Operations Consulting Company 2010-Present

Awards: (1) Applause Award for exceptional Client Service and practice

contributions in 2011, 2012 and 2013

(2) Global Knowledge Sharing Award for developing Health Plan

process model to expedite onboarding of project teams

Senior Manager, Healthcare Strategy & Operations

Led multiple client engagements across Fortune 500 Heath Plan clients

involving provider network, care delivery innovation, operational

transformation, process redesign, system re-engineering, M&A integration

. Corporate Strategy: Led a corporate strategy session for the C-Suite

of one of world's largest health plans to evaluate strategic responses

to emerging provider market trends for sustainable growth in a post

reform era

. Provider Network Analytics: Conceptualized High Value Network tool

that uses "Big Data" to identify, evaluate and organize high

performing providers to manage population and product trends

. ACO Network Design & Implementation: Analyzed market claims and geo

access data to identify candidates for ACO agreements. Designed

provider dashboards to monitor and incentivize cost & quality

performance

. Medicare Claims and Provider Data Migration: Identified future state

capabilities and devised a roadmap to consolidate Medicare claims

platforms to support product and payment innovation, reduce

administrative costs and improve services

. Health Plan M&A Integration: Recommended an approach to integrate care

management practices of two Medicare health plans including

consolidation of case and disease management programs, redesigning

KPIs, creating new staffing models and organizational restructuring

. Medicare Stars Improvements: Identified root causes of low star scores

and recommended an investment roadmap to improve plan's star rating.

. Eminence: (1) Invited as a speaker at University of Michigan, Ann

Arbor, on emerging provider collaboration models

(2) Authored a paper on emergence of elderly

care in India and learnings lessons from developed economies

Manager, Healthcare Strategy & Operations

. Provider Engagement Thought ware :Core member of Deloitte's

Accountable Solution team and developed Deloitte's Point of View

documents on Accountable Care Organizations(ACOs) outlining multiple

provider engagement strategies and network management approach under

Healthcare Reform

. Provider Platform Redesign: Conceptualized and convinced the senior

leadership of large regional plan to redesign their provider

demographic data management system to support new ACO reimbursement

and patient attribution structures

. Provider Payment Redesign: Analyzed and benchmarked medical costs by

hospital systems and recommended potential contracting strategies to a

large regional plan

. Network Expansion: Managed provider network expansion and contract

configuration for a national plan to support launch in new Medicaid

market.

. Eminence: (1) Presented at National Medicaid Conference on Provider

Engagement Strategies to manage Medicaid population

WellCare Health Plans Inc.

Tampa, FL

$ 7 billion Fortune 500 Health Insurance Company 2006-2010

Director, Provider Service Operation & Process Improvement

. Managed $ 7 million P&L and worked closely with COO and VP of Claims

to authorize $4 billion claims payment.

. Led 160 directly and indirectly reporting associates located in 2

offshore and 3 onshore locations.

. Developed & presented 2 year strategic plan to reduce SG&A by 23% by

sourcing, system automation & provider education.

. Convinced senior management to launch Utilization Management

operations in Philippines to reduce operating cost by 30%.

. Launched self-service automated response IVR system to reduce provider

enquiries by 10%.

. Conceptualized and implemented self-service web portal to enable

partner hospitals to request authorizations via web.

. Increased web utilization by 200% through provider outreach &

education.

. Negotiated SLAs & transactions costs with third party vendors to

reduce vendor spend by 20%.

Associate, Corporate Development (Internal Strategy Consulting Group)

. Partnered with Chief Medical Officer and VP of Finance to implemented

Claims Payment Policy and Pricing Committee to manage changes to

claims payment business rules for Medicare and Medicaid businesses.

. Initiated enterprise wide initiative to document and maintain all

claims payment & configuration processes.

. Improved Claims auto adjudication rate by changing authorization rules

& identifying root causes for incorrect denials.

. Developed & implemented workflow to automate contract management and

negotiated pricing with offshore vendors.

. Presented ROI analysis to automate new member enrollment process. This

process utilized OCR scanners to scan member enrollment forms to

offshore location for data entry and was implemented in 2006.

. Led Medicare Expansion initiative in 6 new states across the country.

Initiated a weekly provider network penetration dashboard to monitor

progress of provider network expansion in each state and escalate

bottlenecks requiring senior management and legal attention.

Express Scripts Inc.

St. Louis, MO

$18 billion Fortune 150 Managed Care Organization and leading Pharmacy

Benefit Management (PBM) 2005- 2006

Strategy planning and Competitive Intelligence (CI) Intern

. Conducted due-diligence of $550 million PBM including valuation

analysis & strategic assessment of possible acquisition.

. Performed competitive analysis of top three PBMs and presented

recommendations to stay cost competitive in market.

. Identified key requirements and recommended $1 million CI software to

improve efficiency of the CI team.

Mott MacDonald

Mumbai, India

$600 million UK based multinational consulting organization.

2001-2004

Strategic Planning Consultant

. Expertise in turnaround strategies, growth strategies, M & A and

organizational restructuring.

. Structured a turnaround strategy for $600 million conglomerate

including a 13% cost reduction strategy.

. Increased ROI by 21% of steel wire company by focusing on new markets

and debt restructuring.

. Proposed growth strategy for Government of Oman's Industrial Estate

Authority to promote the growth of manufacturing sector in an oil

dependent economy including financial projections for next 15 years.

EDUCATION

Washington University in Saint Louis - Olin School of Business

St. Louis, MO Master of Business Administration (MBA), Strategy &

Finance

2004-2006

. Recipient of merit based Dean's Scholarship.

. Course in Healthcare Management, Policy and Operations.

. Vice President of Entrepreneurship and Venture Capital club

University Of Mumbai

Mumbai, India

Bachelor of Mechanical Engineering

1997-2001

. Graduated in the top 3% of class.

Other data

Courses Completed "Training the Street" course for Financial

Modeling in MS Excel, MS PowerPoint

Test Scores Scored in the 96th percentile on quantitative section of GMAT

Accolades Ranked among the top five state players in table

tennis

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