Project Quality

VIJU MATHEW

***** ******** ***** ***

Louisville, KY 40245

Mobile: 502-***-****

Email: abj41v@r.postjobfree.com

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PROFESSIONAL EXPERIENCE

Humana, Inc., Louisville, KY, USA

thru Hinduja Global Solutions, Bangalore, India

Group Leader - Operations (Bangalore)

May 2009 - November 2009

. Supervised project teams, including product development and quality

assurance analysts

. Responsible for controlling costs, staffing, and performance of

component projects to ensure ultimate project success and approval

. Implemented various reporting tools for continuous tracking of

project status and performance

. Trained and conducted regular performance appraisals of project

teams to ensure sucessful project outcome within a specified

timeline

.

Business Consultant / Group Leader (Louisville)

November 2007 - April 2009

. Coordinated and negotiated with project managers and off-shore

resources in support of timeline and project deliverables

. Analyzed the level and complexity of effort needed to ensure

project deadlines were met and assigned required resources for each

project

. Initiated and implemented cross training with other departments to

improve workflow and streamline project completion

. Inherited a project that was in jeopardy of being lost due to lack

of performance - through a series of actions, team subsequently

delivered outstanding project that was completed within timeline

and met the client's approval

. Managed project accounts of more $800,000 per annum

. Performed data management and evaluated production targets and

performance on the behalf of client

. Reviewed and regularly implemented, parameters to resolve issues

and assured to maintain performance above the Service Level

Agreement (SLA)

Senior Quality Analyst (Bangalore)

October 2006 - October 2007

. Audited new and existing Health Insurance Plans along with

reviewing and managing of the rebuttal process

. Analyzed and reported monthly quality reports, including a root

cause analysis and implementation of corrective and preventative

actions (CAPA)

. Worked with resources individually to establish areas of quality

improvement and organized a variety of training programs for the

resources in order to improve overall quality performance

Senior Product Development Analyst (Bangalore)

April 2006 - September 2006

. Created various program coding for the automatic execution of

health insurance claims

. Conducted team meetings as a "soft" lead with eight personnel

. Reviewed project and personnel timelines and overall performance to

assure successful project outcome

Quality Analyst (Bangalore)

October 2005 - April 2006

. Audited processed claims and analyzed data to generate monthly

quality reports

. Reviewed over and underpayments, assuring correct reimbursements

. Adjudicated claims over $15,000

Claims Processing Analyst (Bangalore)

July 2004 - September 2005

. Processed U.S. healthcare insurance claims including Medicare and

Medicaid claims

. Knowledge of ICD9.0, HCPCS, CPT and Revenue Codes and their

applications

. Trained to handle specialization codes as a Code Review Specialist

. Handled claims from high profile Administrative Services Only (ASO)

Groups

EDUCATION

. Bachelor of Engineering, Electronics and Instrumentation from Tamil

Nadu College of Engineering, India, 2004

. Associates Degree in Electronics and Communication from Kerala

Institute of Engineering and Technology, India, 2000

ATTRIBUTES

. Demonstrated successful customer relations management

. Extensive supervisory skills and time management to multiple

applications

. Consistent successful outcomes while collaborating with multiple,

diverse cultures

. Technical knowledge (Microsoft Excel, Microsoft Word, Lotus)

. Strong work ethics

. Bilingual

* Authorized to work in United States of America

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