Milind Phadke

• Executive Relationship Management: Build and maintain strong relationships with executive leadership to understand their strategic priorities and challenges.
• Process Assessments: Conduct comprehensive process assessments and diagnostics to identify areas for improvement.
• Transformation POV: Develop a POV on potential transformation opportunities and process improvements.
• Future State Design: Design the future state of processes, ensuring alignment with business goals.
• Business Architecture: Serve as a business architect, leading the design and implementation of process improvements.
• Initiative Leadership: Lead complex, large-scale process improvement initiatives from inception to completion.
• CoP & CoE: Help build a process improvement and Lean Six Sigma (LSS) community by providing Black Belt (BB) training and mentoring BB & GB projects.

Additional Responsibilities:

• Stakeholder Engagement: Engage with various stakeholders to gather insights and ensure alignment with process improvement goals.
• Continuous Improvement: Foster a culture of continuous improvement by identifying and implementing best practices.
• Performance Metrics: Develop and track performance metrics to measure the success of process improvement initiatives.
• Training and Development: Conduct training sessions and workshops to upskill team members and promote a culture of excellence.
• Fostered a culture of continuous improvement within the organization, empowering employees to contribute ideas for process enhancements actively
• Championed process improvements that resulted in significant cost savings and enhanced operational efficiencies

• Member and Provider Journey mapping based on member and provider pain points/verbatim
• Analyzing business process and identifying RPA automation opportunities and assess automation feasibility from Journey mapping
• Analyzing, understanding and documenting business processes in detail where required
• Conduct discovery sessions with Operation SME's
• Developing AS-IS and TO-BE process flows
• Supported Automation to create BRD
• Drive Lean Six Sigma quality culture in organization
• Identify issues and challenges, lead/facilitate improvement projects, measure and validate project results, and facilitate successful implementation of all facets of process improvements or changes identified
• Execute data-driven, statistical approach to problem solving, including gathering, analyzing and reporting data
• Define appropriate metrics to gage processes performance through structured reporting governance model
• Presenting project analysis and findings to senior leadership to obtain approval, funding and other requirements to resolve issue
• Manage end to end Improvement Ideation program
• Responsible for process trainings deployment which includes training need identification, preparation of training decks and training delivery
• Partnered with RPA Team to deliver RPA Automation Projects such as DEV ( Data Entry Validation, Unified Screen Automation (UiPath) 15+ worth FTE Savings
• Collaborate well with US quality & operations teams
• On Going E2E Accuracy Improvement Project impacting $10 MN soft save
• Achieved $ 2 MN Hard Save from Automation Projects
• Achieved around $15 MN, Medical cost avoidance
• Improved AHT from 12 Claims Per Hour to 18 Claims Per Hour
• Drive Overpayment Recovery Projects to eliminate Incorrect Denial

• Support Cosmos / CPW claim processing functions including investigations, negotiating settlements, payments, research regarding eligibility, etc.
• Uses pertinent data and facts to identify and solve range of problems within area of expertise.
• Effectively managed 4 different teams with overall team size of 65+ including 2 Assistant Manager, 2 SME's and 1 Process Expert
• Collaborated between Document Experts and Ops SME for process re-engineering
• High Level Process Mapping on Audit Methodology
• Analyzed business requirements to determine if existing systems/processes are optimized to achieve those goals, and to identify potential Automation opportunities/Fixing Issues
• To identify root causes of identified claims processing problems/issues (e.g., root cause analysis, workflow analysis)
• To Identify/analyze current business processes and determine how well it meet business requirements
• Leverage applicable industry standards/benchmarks, and identify opportunities for improvement based on industry standards
• Utilize applicable service standards and other key performance metrics to drive identification of potential problems/issues/opportunities (e.g., performance guarantees, service level agreements, state contract requirements)
• Develop appropriate measurement approaches/metrics to evaluate effectiveness of recommended solutions/process changes(e.g., financials, time to pay, performance guarantees)
• Perform testing/piloting of potential changes to business processes, and ensure effectiveness prior to implementation
• Identify applicable stakeholders and obtain appropriate approvals/buy-in for recommended process improvements (e.g., leadership, business partners)
• Helped to develop rules on Payment Integrity to stop incorrect processing done by System and Manual Processing
• Partnered with Prepay team to develop in build algorithm

• Trained new hire folks for 7 waves, with overall HC of 100+
• Maintained High Accuracy level, closely monitored upward Productivity
• Introduced PAL program for folks struggling to achieve accuracy and productivity.
• Worked for Various Process Improvement Projects to drive Accuracy from 94% to 98% and Productivity from 8 CPH to 12 CPH
• Partnered with Onshore Teams to fix gaps between SOP's, around 20+ SOP's redesign
• Enhance Member and Provider Experience by Reducing CTM defects by 10 to 2 defects /month
• Collaborated with team members to achieve target results
• Identified issues, analyzed information and provided solutions to problems

• Serve as subject matter expert in CPW/COSMOS and provide clarification and streamline 10+ SOP guides in collaboration with Onshore partners
• Provide assistance to individuals with questions that arise regarding process policies, procedures and processes
• Answer questions and/or direct individuals to proper policy and procedure for review
• Provide Quality Assurance or Secondary reviews for volumes assigned and give timely feedback to staff
• Provide and/or create any additional job aids as determined based on questions and comments received from staff
• Create and update knowledge library/SOPs from time to time
• Provide additional training on process policies and procedures and provide real-life examples relating to areas in question
• Support individuals through training program and on floor by providing immediate feedback on work performed
• Active participation in conference calls with onshore counterparts and other stakeholders
• PKT (Process Knowledge Test) assessment to be conducted once in month and ensure feed backs are provided basis results
• Error Analysis to be done for process, weekly or monthly as appropriate
• Periodic audits performed within all teams to check for adherence and reports should get published on findings
• Drive quality projects and continuous improvement projects within team
• Prepare and submit training reports on weekly basis for new hires
• Maintain accuracy rate (OAR) as defined by process

• Around 3+ years of experience on Adjudication of Dental/Medical Claims
• Knowledge of Mainframe screens COSMOS/UNET/TOPS
• Established new audit teams to deliver high accuracy scores
• Auditing/Training Handled most of work Queues in Traditional Processing, Rework, Electronic Data Handling System
• To analyze Diagnosis Codes and procedure codes submitted on HCFA form and reimburse of payments to Members/Providers

• Handled most of the projects in the team
• (Traditional processing, Reworks, Electronic Claim Handling System)
• Worked as mentor and auditor to the processor for the new projects
• To analyze the diseases submitted in the form of codes by doctors and to reimburse of payments to the doctors/members for a USA based Health Insurance Company
• Good Knowledge about CDT codes (American dental association codes) and HIPAA privacy rules
• To analyze the various codes (diseases) submitted by the doctors in the form of claim, patient history, prior records, x rays, perio charts and other rationale and give correct benefit to the patients
• Train the processors for new projects and updates
• To acquire sufficient knowledge regarding processing and educate the whole team