Purushotham Nair. N Email: acw71a@r.postjobfree.com, Mobile: +919*********

Objective

To be a key contributor for the organization in line with specified procedures and standards, where my potential is utilized and where I can have the principles to live by, profession to live out and the power to live on.

Experience Summary

XL Health Care: Working in XLHealth as Quality Analyst from Oct’01 2011 To Aug’ 08 2016

Hinduja Global Solutions, Bangalore: Worked in HGS as Sr. Claim Processing Executive & Auditor

from Aug’11, 2006 to Apr’09, 2010

Skills

Proficient in MS Outlook, MS Word, MS Excel, MS Power Point & Lean Six Sigma Green Belt Certified.

Work Experience

As Quality Analyst, I have been handling a number of major roles and responsibilities (below mentioned) with XLHealth Care.

Company: XLHealth Care

Duration: Oct’01 2011 to Aug’08 2016

Position: Quality Analyst

Job Profile:

Working as a quality analyst for C&S (community & State) Appeal & Grievance process (Medicaid) & Medical claim processing (Medicare). For Appeals Audit which the provider is not satisfied for the compensation from the insurance company or member is not satisfied for the service from the provider those types of issue will be validating through the applications called ETS (Escalation tracking system)

and to valid the details through Macess csp, Iset, Cosmos, Careone, facets 5.01 & R.V.Facets. CSP Facets applications.

Work Description:

Profile and Responsibilities:

Insurance terminology, meeting clients requirement on time, maintaining day to day TAT and SLA(service level agreement)

Specialization on specific groups

Prepare and Review Production and Quality reports and shared with clients on monthly basis.

Trained new hires on domain knowledge.

Understanding all the binding laws and regulations related to project.

Expert on different state insurance plans (US).

Auditing closely with compensation and service team to settle down the issues raised by the customers’ satisfaction.

Understanding the ethics and compliance of HIPAA.

Had proposed improvements to the process and suggested measures to improve quality productivity by reducing time, work & improving the accuracy levels of process;

Recognized by US Counterpart for all my hard work

Corporate Training:

Undergone for Fish Tail program & Associate Development Program Level 1 and 2 conducted by Learning and Development@XLHealth.

As Sr. Claim Processing Executive, I have been handling a number of major roles and responsibilities (below mentioned) with HGS Global Solutions.

Company: Hinduja Global Solutions

Duration: Aug’11 2006 to Apr’09 2010

Position: Sr. Claim Processing Executive & Internal Auditor

Company Profile:

HGS (Hinduja Global Solutions). HGS has emerged as an IT company that delivers time and cost effective solutions to its vast and diverse Clientele all over the world, adding value and simplifying life for its customers. Business Process Outsourcing (IT Enabled Services-ITES) Processing of Healthcare Insurance Claims.

Our Clients include one of the largest Healthcare Insurance Providers in the U.S. & a leading Provider of Claim Reporting & Customer Services in the United States.

Work Description:

Profile and Responsibilities:

Insurance terminology, meeting clients requirement on time, Adjudication, maintaining TAT and SLA(service level agreement)

Specialization on specific groups

Trained new hires on domain knowledge.

Expert on different state insurance plans (US).

Working closely with compensation team to settle down the issues raised by the customers and processors regarding release of payment.

Academics

B.Com Computer Applications from Sri Venkateswara University, Tirupathi.

INTERPERSONAL TRAITS AND ATTITUDE:

Dynamic, target oriented team player, highly self-motivated with innovative and implementable ideas. Good listening comprehension. Push myself every day and exceed each day with challenge and be on top of it.

Personal Particulars:

Date of Birth: 02 Oct 1978

Gender: Male

Nationality: Indian

Marital Status: Married

Passport Number: E6940308 & P5003351

B1/B2 Visa: 10 Years

Expired on 4th Jan’2017

Languages:

English, Hindi, Malayalam, Telugu, Tamil, Kannada.

Bangalore Purushothaman Nair.N

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