Project Medical

CAREER VISION

Seeking for a challenging position, in the highly competitive and focused

Service Delivery/Customer Support Operations where my skills and knowledge

can be enhanced, shared, applied and enriched. I look forward to a position

that would synergize personal interest and abilities with organizational

goals.

Summary of Work Experience

5 yeas of working experience in MNCs.

Experience Present :

Jan 2010 - Sept 2012

WIPRO Ltd.

Senior Executive Operations (Non Voice)

Project Associated: United Health Group

Work Profile :

Worked as a Medical Claims Adjudicator for a USA Based leading Health

Care organization.

. SME (Subject Matter Expert).

> Giving support to the team, in case of processing medical claims

& doing audits to prevent External & Internal error.

> Provide new updates about processing of claim to the team.

> Monitoring team's Production as well as Quality.

. Before being a SME worked as a Trainer

> Trained 2 new batches of 24 trainees each for operations.

> Duration of the training was 3 months for each batch.

. Worked as a claims adjudicator, the job profile included:

> Adjudicating Medical Claims.

> Maintained Good Production as well as Quality while

adjudicating.

> Received recognition and awards on several occasions for being

the Best Performer.

. Was part of a Special project to meet client requirement that required

handling of complex claims.

> Correcting the mistakes previously made by others.

> Motto was to prevent errors.

> Received appreciation from Client.

> The employer got a new queue for the good work provided.

. Monitoring the quality of Process associates and providing proactive

feedback to enhance productivity.

Professional Accomplishments:

< Certified in High Dollar ($ 1,50000) Auth Claims by Client Site.

< Certified in Medicare Processing.

< Certified in Medicaid Processing.

< Certified in Other Insurance Processing.

< Certified in Outpatient Claim Processing.

< Certified in Pre-Existing Processing.

< Well-acquainted with REPRICING Claims.

From may 2007 - Nov 2009 IBM .Ltd

Position: - Executive Operations (Voice)

Worked on Project Reducing Repeat calls, Handle Escalation Calls.

Work Profile :

. Take Escalation Calls.

. Give Briefing on daily basis to the agents regarding product and

process related.

. Handling FCR(first call resolution)-Calculation, Dashboard and

sharing feedback with the agents in order to enhance the Process

FCR

. Monitoring CMS in Daily Basis to Maintain AHT, SL and Break

Professional Qualification

V Windows 2000;Microsoft

word,excel,powerpoint,access,publicer;adobe illustrator

Photoshop, outlookExpress; scanning technology: HTML; internet

Proficient.

Academic Qualification

V B.A (Economics) from Ravanshaw Autonomous College under Utkal

University, in the year 2006.

V +2 arts from Ravenshaw junior college, Cuttack under C.H.S.E

Bhubaneswar, Orissa in 2003.

V H.S.C from Ganeswarpur High School, puri under B.S.E, Orissa in

2001.

Personal Profile

1. Name :: Bibhuti bhusan Sethy

2. Fathers Name :: Late Madhab Chandra Sethy

3. Date of birth :: 11th may 1986

4. Gender :: Male

5. Nationality :: Indian

6. Language proficiency :: English, Hindi, oriya, Bengali.

1

Contact this candidate