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Kaveen Kumar

Senior Claims Adjudication SME | Medicare, Marketplace & Commercial Claims | Amisys | Healthcare Operations | Process Improvement

Chennai

8+ years of work experience

Cognizant
Jul 20232 yrs 11 mosPresent

Chennai

• managing a 30+ member team in claims adjudication. • Drive team performance to achieve and exceed SLA metrics for accuracy, turnaround time, and productivity. • Monitor daily operations, allocate work, and ensure timely resolution of complex claim scenarios. • Mentor and coach team members to improve skills, process understanding, and overall quality. • Foster a culture of accountability and continuous improvement, resulting in consistent KPI achievement.
NTT DATA
Nov 20202 yrs 8 mosJun 2023

Chennai, Tamil Nadu, India

• Processed Medicare claims using Amysis with a focus on accuracy and compliance. • Handled special projects and acted as SME backup for team clarifications. • Managed escalated claims and ensured SLA adherence. • Contributed to process improvements, reducing rework rates and improving team productivity.
Accenture
Mar 20182 yrs 6 mosAug 2020

Chennai, Tamil Nadu, India

Processed all types of healthcare claims using WGS application. • Maintained SLA performance while ensuring compliance with payer policies. • Identified system/process issues and supported improvement initiatives. • Consistently achieved top-tier quality scores in internal audits.

Education

Bachelor of Commerce, Accounting

Tagore College Of Arts And Science

20143 yrs2017

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Headline

Senior Claims Adjudication SME | Medicare, Marketplace & Commercial Claims | Amisys | Healthcare Operations | Process Improvement

About

US Healthcare Claims SME with 7.5+ years of experience in Medicare and Marketplace claims adjudication. Currently working with Cognizant on Centene project, specializing in claims adjudication, audit, appeals, and payment accuracy using Amisys. Experienced in: • End-to-end claims processing and manual pricing • Appeals handling and overpayment recovery • Audit and quality improvement initiatives • Managing team allocation and SLA adherence • Handling onshore escalations and complex claims issues Previously worked with Accenture and NTT Data on Medicare claims. Strong focus on reducing errors, improving productivity, and ensuring compliance with payer guidelines. Open to opportunities in Senior Analyst / SME / Quality roles in US Healthcare domain.

Location

Chennai

Work experience

Subject Matter Expert at Cognizant, Jul 2023 - Present · 2 yrs 11 mos, Chennai, • managing a 30+ member team in claims adjudication. • Drive team performance to achieve and exceed SLA metrics for accuracy, turnaround time, and productivity. • Monitor daily operations, allocate work, and ensure timely resolution of complex claim scenarios. • Mentor and coach team members to improve skills, process understanding, and overall quality. • Foster a culture of accountability and continuous improvement, resulting in consistent KPI achievement.

HC & Insurance Operations Associate at NTT DATA, Nov 2020 - Jun 2023 · 2 yrs 8 mos, Chennai, Tamil Nadu, India, • Processed Medicare claims using Amysis with a focus on accuracy and compliance. • Handled special projects and acted as SME backup for team clarifications. • Managed escalated claims and ensured SLA adherence. • Contributed to process improvements, reducing rework rates and improving team productivity.

Transaction processing executive at Accenture, Mar 2018 - Aug 2020 · 2 yrs 6 mos, Chennai, Tamil Nadu, India, Processed all types of healthcare claims using WGS application. • Maintained SLA performance while ensuring compliance with payer policies. • Identified system/process issues and supported improvement initiatives. • Consistently achieved top-tier quality scores in internal audits.

Education

Bachelor of Commerce, Accounting, Tagore College Of Arts And Science