04 Years Experience Insurance

K Sudheer Kumar

Hyderabad, India

Mobile: +91-967-***-****

E Mail: *******.*********@*****.***

H No: 12-2-417/A/4-G1, Sri Sai Nilayam, Jayanagar LIC Colony, Gudimalkapur,

Mehdipatnam, Hyderabad - 500 028

Process Operations Professional

3.5 years experience in the KPO Industry - Expertise in the USA HEALTH

INSURANCE

Total of 6.5 years exp in HEALTHCARE Industry

OBJECTIVE

Seeking a challenging position in a professionally managed & reputed

organization where my functional skills & competencies can be effectively

used for contributing to the success of the organization and can be further

enhanced for mutual benefit.

PROFESSIONAL SYNOPSIS

< Competent and resourceful Claims Analysis & Process Operations

professional with 3.5 years experience in with excellent understanding

of business dynamics

< Proven expertise in handling Claims in the Insurance Domain

< Expertise in conducting & fulfilling various process operations while

ensuring Quality Checks

< Excellent Product & Process Knowledge

< Proven ability in preparing Standard Operating Procedures (SOPs) and

Process Maps

< Demonstrable track record of success in achieving budgeted goals

within defined time lines

< Good exposure to Customer Relationship Management

< Systematic and diligent individual having aptitude towards

independently handling assigned tasks as well as team tasks aimed at

achieving organizational goals with sophistication and finesse

< Versatile and multi-skilled with ability to manage multiple

responsibilities simultaneously, achieve defined goals & objectives,

an effective communicator with Strong Analytical, Problem Solving &

Organizational Skills

< An experienced Self Starter and Team Manager with keen attention to

organization needs and details

MANAGEMENT SKILLS

V Hands on Process Operations professional with a mind for process and

numbers

V Ability to conceptualize new processes

V Analytical & logical thinking

V Solution oriented thinking

V Time driven delivery ability

V Excellent Interpersonal Skills

CORE COMPETENCIES

? Process Operations ? Business Process

Management

? Business Analysis / Sector Valuation ? Expertise in

Insurance Domain

? Gap Analysis ? Industry/Domain Analytics

? Process Improvements ? Quality Assurance

? Process Compliance ? Auditing, Inspection &

Verification

? Data Analysis & Extraction ? Customer Relationship

Management

? Issue Resolution ? Training - Product & Process

? Report Making ? Liaisoning & Coordination

ACADEMIC CREDENTIALS

> Bachelor of Commerce (B.Com),

Bundelkhand University, Jhansi, U.P

> Intermediate,

Board of Senior Secondary Education, U.P

> Secondary School Certificate Examination (SSC),

Board of Secondary Education, U.Ps

TECHNICAL QUALIFICATIONS

> GNIIT (Web Centric Curriculum) 2 years course from NIIT

> DCA (Diploma in Computer Application) from APEL institution

> CCA (Certificate in Computer Application) from NICE institution

IT SKILLS & PROFICIENCY

Operating System : Windows 2003 / 2007

Application Packages : MS Office

Internet Applications & Tools

PROFESSIONAL EXPERIENCE

UnitedHealth Group (UHG), Hyderabad

Nov'2010 - Apr'2014

Process Expert (TL)

Joined as Claim Process Executive and promoted as Process Expert (TL)

Responsibilities

< Primary responsibility of handling Claims processing initially for

Physician Claims (6 Months) & later Autism Claims

< Be responsible for 100% Production & Quality

< To be responsible for error free operations

< Responsible for analyzing U.S Healthcare Claims Adjudication on Web

based Facets Application and Mainframe based UNet Application

< To design and create Charts, Graphs and PPTs based on Data updates

received from client

< To Audit the Claims processed by the Team members

< To conduct internal audits of claims which are processed by the

processing associates

< Responsible for meeting key metrics like Turn Around Time (TAT) and

Quality

< To verify various documents to ensure a non-duplicate claim submission

to avoid over payment

< To handle the assignment allocation to the team based on competencies,

delivery ability etc.

< To check for any problem, fault or error in the project and escalate

on the same

< To handle and monitor the team on their individual productivity

< To handle calls from clients for any issues

< To continuously assess study processes, conceptualize new processes

for improving productivity and deliver better solutions within defined

TATs

< To send the Monthly or Daily Reports to the Management for reviews

< To comply with reporting methodology with supervisors on regular as

well as need basis

Value Labs, Hyderabad

Oct'2007 - Oct'2010

Customer Support Representative

PROJECTS

SHPS

SHPS is a leading, independent provider of integrated health solutions that

improve personal health and reduce spending. By integrating traditional

health management and benefits administration services, SHPS delivers

people-centric solutions that empower individuals to make wise healthcare

choices. It serves large and mid-sized employers, government agencies, and

third-party administrators through the company's Carewise Health, Landacorp

and SHPS brands

Health Care Claim Processing

A health insurance claim is a bill for health care services that your

health care provider turns in to the insurance company for payment. Apart

from Health care claim processing, we also enroll the new members into SHPS

along with the American Recovery and Reinvestment Act (ARRA) and other

subsidies

Dependent Care

< Care for a child under age 13 at a day care, day camp or nursery

school, or by a private sitter for a child that lives in your home for

at least eight hours a day.

< Elder care for an incapacitated adult who lives with you at least

eight hours a day.

< Expenses for pre-school and after-school child care (these expenses

must be kept separate from any tuition expenses)

< Cost of a housekeeper whose duties include the care of a qualifying

dependent

Commuter (Transportation and Parking)

All the parking and transportation charges are reimbursed

Project - Snapfish

Email and Chat Process

< Responsible for handling queries of customers through CHATTING or the

CALLS from US, UK, Australia, Canada, India and Singapore

Project - Pricegrabber - http://www.pricegrabber.com

< I will be collecting the technical specifications from manufacture and

merchant websites of newly launching products and entering the

collected data for the product in specified application.

< Miscat - I will be moving the products which are in wrong location to

the correct location.

HOBBIES & INTERESTS

* Sports Enthusiast

* Travelling

* Listening to Music

* Expanding knowledge through the Internet

DATE:

K.SUDHEER KUMAR

PLACE:

(Name and Signature)[pic]

Contact this candidate