Amit Sawarkar
Pune,MH
Summary
Results-driven Senior Specialist in Payment Accuracy with extensive experience at Cotiviti India Pvt. Ltd., skilled in claims auditing and team leadership. Demonstrated expertise in compliance monitoring and analytical problem-solving, successfully transitioning projects and improving audit efficiency without direct onshore training. A proven track record of maintaining high accuracy standards while optimizing processes through effective team coordination.
Overview
10
10
years of professional experience
Work History
Senior Specialist Payment Accuracy
Cotiviti India Pvt. Ltd.
Pune, MH
07.2018 - Current
- Analyzed provider contracts and related documents to verify accurate rates for specific services
- Audited healthcare claims for UHC data mining projects, including pharmacy claims, to identify and rectify overpayments
- Performed platform-specific audits for pharmacy claims adhering to unique requirements.
- Processed and resolved provider appeals on written claims, ensuring compliance with policies and procedures
- Spearheaded the successful transition of the Multiple Procedure Reduction project without onshore training, relying on SOPs and domain expertise
- Collaborated with cross-functional teams to streamline processes and enhance audit efficiency
- Provided training and mentorship to new team members on project protocols and audit techniques
- Managed escalations and work assignments for the team to ensure smooth operations and timely resolution
Senior Process Analyst
Gallagher Offshore Support Service Pvt. Ltd.
Pune
12.2014 - 06.2018
- Gathered and organized all data related to claims, ensuring accurate generation of claim numbers
- Addressed and resolved queries from Claims Adjusters to facilitate smooth claim processing
- Dispatched complete and accurate claim data to Claims Adjusters in a timely manner
- Provided comprehensive support to Claims Adjusters throughout the claims resolution process
- Maintained meticulous records of claims and ensured adherence to compliance standards
Education
B.Sc. -
Amravati University
01.2009
H.S.C. -
Maharashtra Board
01.2004
Skills
- Claims Auditing
- Compliance Monitoring
- Data Interpretation
- Effective Team Coordination
- Analytical Problem Solving
- Guidance and Support
- Detail-Oriented Mindset
Accomplishments
- Received Quarterly Awards for Continuous target achievements and Process improvements.
- Received Appreciations from higher level authority on identifying new scenarios to achieve targets.
Disclaimer
I hereby declare that the above-written particulars are true to the best of my knowledge and belief.
Timeline
Senior Specialist Payment Accuracy
Cotiviti India Pvt. Ltd.
07.2018 - Current
Senior Process Analyst
Gallagher Offshore Support Service Pvt. Ltd.
12.2014 - 06.2018
B.Sc. -
Amravati University
H.S.C. -
Maharashtra Board