DENASHA PANDY
Capitol Bridge
Oxon Hill,MD
11
years of professional experience
Detail-oriented and results-driven Healthcare Claims & Operations Professional with over 4 years of experience managing complex claims processing, regulatory compliance, public health data, and intake workflows. Proven track record of high-accuracy audit reviews, cross-functional collaboration, and leveraging data visualization tools (Power BI, Salesforce, enterprise databases) to streamline operations. Fully equipped for remote-first environments, with demonstrated success independently managing high-volume workloads and strict compliance standards in virtual settings.
Work History
Claims Reviewer
10 Months- Highlight high-volume accuracy, regulatory compliance, and virtual execution:
- Conduct thorough audit and quality reviews of healthcare claims and documentation to ensure strict alignment with federal, state, and organizational compliance guidelines.
- Utilize enterprise databases and specialized software to process, verify, and resolve complex claim disputes and prior authorization requests with a [X]% accuracy rate.
- Collaborate seamlessly with cross-functional teams via Microsoft Teams and virtual communication tools to resolve escalated cases efficiently.
- Generate weekly data reports using Power BI to identify claims processing trends, backlog bottlenecks, and operational quality metrics.
Intake Processor / Operations Coordinator
10 Months- Highlight intake efficiency, software proficiency, and operational throughput:
- Managed the end-to-end intake pipeline for high-volume incoming documentation and requests, utilizing Salesforce to track case statuses and maintain compliance.
- Evaluated initial file completeness, flagged discrepancies, and communicated securely with internal stakeholders to expedite processing times by [X]%.
- Maintained data integrity across legacy mainframe databases and cloud-based platforms, adhering strictly to HIPAA and data privacy regulations.
- Assisted in refining intake standard operating procedures (SOPs) to support remote and hybrid team workflows.
Claims Adjuster / Insurance Specialist / Team Lead
8 Years 6 Months- Highlight leadership, customer resolution, and transferable claims experience:
- Reviewed, investigated, and adjudicated complex insurance claims while delivering top-tier customer service and conflict resolution.
- Led quality control reviews and mentored team members on compliance standards, policy guidelines, and workflow management systems.
- Tracked operational KPIs and collaborated with senior leadership to optimize team productivity and resolution turnaround times.
Education
Master of Public Health (MPH)
Bachelor of Arts - Sociology
Skills
Healthcare & Claims: Claims Review & Adjudication
Prior Authorization
Regulatory Compliance
Quality Assurance & Auditing
Utilization Management
Medical/Health Terminology
Public Health & Data: Public Health Data Analysis
Program Operations
Workflow Optimization
Power BI Dashboard Reporting
Data Management & Compliance
Software & Systems: Microsoft Teams
Salesforce
Mainframe Databases
Enterprise EHR/Claims Databases
Microsoft Office Suite / Excel (VLOOKUPs
Pivot Tables)
Remote Operations: Asynchronous Communication
Virtual Collaboration
Independent Time Management
High-Volume Data Processing
CUST
Security Clearance: Active Secret Clearance
Timeline
Claims Reviewer
Capitol Bridge
12.2025 - CurrentRead More
Intake Processor / Operations Coordinator
Mind Computing
11.2024 - 09.2025Read More
Claims Adjuster / Insurance Specialist / Team Lead
AAA Carolinas
07.2015 - 01.2024Read More
Southern New Hampshire University
Master of Public Health (MPH)
Read More
Southern New Hampshire University
Bachelor of Arts from Sociology
Read More