Khaja Mohiddin S
Hyderabad
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Business Analyst
Carelon Global Solutions
Hyderabad
12.2024 - Current
- Performed daily, weekly, and monthly reviews and analyses of current processes using operational metrics and reports.
- Managed projects and served as primary liaison between client and multiple internal groups to clarify goals and meet standards and deadlines.
- Maintained library of model documents, templates or other reusable knowledge assets.
- Conducted detailed business analysis, outlining problems, opportunities, and solutions for a business.
- Calculated and processed payments for sales commissions.
- Handled inquiries from customers regarding their commission payments and provided timely responses.
- Provided technical support during user acceptance testing cycles.
Analyst Quality Control
Carelon Global Solutions
Hyderabad
05.2022 - 11.2024
- Conduct basic activities as GEMBA, PKT, Refresher, Quality Connect with Operations team
- Strong experience in Claims Life Cycle and with good understanding of Business Rules & Other Anthem Applications Prioritize requirements, collect data, deep dive and provide meaningful insights
- Train and mentor new QAs, Conduct internal calibrations on fixing knowledge gap
- Audit the IQT’s and provide feedback to team and educate on trending scenarios
- Connect with Operations, OE to discuss process updates and share Audit feedback
- Live Audits thru floor support
- Ability to utilize 7 Quality Tools for overall Quality Improvement Mentor QAs and co-workers and help them enhance the business delivery
- Share month wise report with leadership and Operations and gather the action plan
- Cross trained on entire Host Correspondence and Adjustments.
- Performed root cause analysis on non-conforming materials to identify problems and corrective action plans.
- Reviewed, analyzed and documented data related to quality assurance processes.
- Conducted audits of internal systems, processes, products and services in order to assess their effectiveness.
Associate
Carelon Global Solutions
10.2019 - 04.2022
- Currently working as Claims Associate completely into review of provider correspondence and follow-up based on provider question
- Worked on Ad-hoc project requirements for Central States, NE & GA Provider correspondence
- Review BPM framework and work on Correspondence misrouted to member group plan thru Blue Square
- Working on UAT for NextGen Case
- Analyze the provider issue regarding the claim and route Inquiry to follow-up team and adjust the claim if needed maintaining 100% quality
- Follow-up with Pre-Pay and Post-Pay audit team regarding the pricing denials
- Trained Central Correspondence Team for Invalid Adjustment Returns.
Claims Associate (AR Caller)
Hinduja Global Solutions Limited
03.2018 - 09.2019
- Worked as Claims associate completely into review of claims and forwarding to client
- Handle hard edit on Relay for UB04 claim and bill it to correct payer ID
- Worked on Case Management and Coding denials
- Worked on Charity Care claims, Hospice, Auto Insurance and Workers Compensation
- Delivered US Healthcare process training and mentored new folks.
Internship Student
Wipro Technologies
Hyderabad
07.2015 - 02.2018
- Organized data into spreadsheets and databases for easy access by other departments.
- Researched industry trends and best practices related to specific projects.
Education
Bachelor of Computer Science -
Rayalaseema University
Kurnool, Andhra Pradesh01.2015
Intermediate - Maths, Physics, Chemistry
Sri Ramaiah Junior College
Kurnool, Andhra Pradesh01.2012
Standard X: CBSE -
St. Joseph High School
RayalaseemaCarelonCarelonMathsRamaiahKurnool, Andhra Pradesh01.2010
Skills
- Ability to learn new technologies and quickly get adapted to different work environment thereby having the diagnostic ability to solve complex issues
- Strong perseverance and diligence towards attaining challenging goals and effective time management
- Self-motivated, excellent team player with proven leadership skills
- Excellent communication and interpersonal skills
- Ability to establish and maintain effective working relationships with co-workers, managers, and internal/ external customers
- Business Operations Analysis
Certification
Lean SIX Sigma Green Belt Certified thru AIGPE on 09/11/23.
Hobbies And Interests
- Surfing Internet,
- Traveling
- Exploring AI Tools
Languages
English
Full Professional
Urdu
Native/ Bilingual
Hindi
Native/ Bilingual
Telugu
Native/ Bilingual
Timeline
Business Analyst
Carelon Global Solutions
12.2024 - Current
Analyst Quality Control
Carelon Global Solutions
05.2022 - 11.2024
Associate
Carelon Global Solutions
10.2019 - 04.2022
Claims Associate (AR Caller)
Hinduja Global Solutions Limited
03.2018 - 09.2019
Internship Student
Wipro Technologies
07.2015 - 02.2018
Bachelor of Computer Science -
Rayalaseema University
Intermediate - Maths, Physics, Chemistry
Sri Ramaiah Junior College
Standard X: CBSE -
St. Joseph High School