Divya Bhatia
Cumming,GA
Summary
Licensed Pharmacy Technician and Healthcare Operations Professional with 7+ years of experience across Medical Scheduling, Claims Adjudication, Healthcare IT, and Customer Service. Proven ability to streamline workflows, enhance patient experience, and support clinical teams through accurate scheduling, insurance verification, and EHR documentation. Recognized for strong analytical skills, process optimization, and exceptional communication in fast-paced, regulated environments.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Associate Business Consultant
Infosys Ltd.
Remote
04.2022 - 02.2025
- Served as Subject Matter Expert for Health Rules Payor platform, guiding end-to-end claim processing for government healthcare programs.
- Designed, authored, and standardized comprehensive SOPs for claim adjudication workflows in alignment with client and regulatory requirements.
- Worked closely with the Medi-Cal client to translate business rules into operational processes, ensuring accuracy and compliance.
- Provided daily guidance to offshore operations teams, delivering training, clarifying requirements, and resolving complex claim scenarios.
- Identified workflow gaps and implemented process improvements that increased claim accuracy and reduced rework.
- Ensured claim processing aligned with government program standards, audit expectations, and Health Rules configuration guidelines.
- Partnered with configuration, QA, and operations teams to validate rule changes and support smooth production deployment.
- Supported patients, providers, and healthcare teams with clear communication and process guidance.
- Resolved complex issues including billing discrepancies, system errors, and escalated service concerns.
- Created SOPs and training materials to improve team efficiency and accuracy.
- Delivered high-quality customer service, contributing to an 18% increase in client retention.
- Mentored junior staff and ensured compliance with healthcare guidelines.
Appeals Analyst
Delta Dental
Alpharetta
09.2021 - 03.2022
- Led compliance discussions to improve process efficiency and team alignment.
- Reviewed and processed dental claim appeals, ensuring adherence to guidelines.
- Provided clear explanations of denial reasons and next steps to members and providers.
- Tracked appeal outcomes and identified trends to improve resolution strategies.
- Collaborated with cross-functional teams to resolve complex customer inquiries efficiently.
- Streamlined appeal review process, reducing turnaround time for resolutions significantly.
Claims Business Analyst
Aliera Healthcare
Sandy Springs
07.2019 - 07.2021
- Led data migration to Health Rules Payor, ensuring accuracy and seamless transition.
- Handled 30+ daily inquiries regarding claims status, coverage, and billing issues.
- Reviewed prior authorizations and communicated decisions to members and providers.
- Trained new hires on claims workflows and customer service best practices.
- Captured and validated business requirements for platform transformation.
- Resolved claim discrepancies, reducing reprocessed claims by 30%.
- Collaborated with providers to verify CPT codes and ensure accurate reimbursement.
- Maintained strict HIPAA and compliance protocols.
Claims Analyst (Medicaid)
Gateway Health Plan
Pittsburgh
10.2018 - 06.2019
- Adjudicated high-value Medicaid claims in compliance with COB policies.
- Resolved complex Tier 2 and Tier 3 claims, improving processing efficiency.
- Implemented CMS and state guidelines to enhance claim accuracy.
- Performed detailed claims adjustments, significantly reducing errors.
- Improved claim resolution efficiency through analysis of complex Medicaid cases.
Associate Software Engineer
UnitedHealth Group
India
07.2011 - 04.2012
- Enhanced Adjudipro system efficiency through functionality mapping.
- Designed detailed models to improve project accuracy and precision.
- Optimized data-gathering strategies for improved information flow.
- Prepared clear specification documents to guide project development.
- Contributed to innovation initiatives within the team.
- Collaborated with cross-functional teams to drive software development projects from concept to deployment.
Education
Bachelor of Technology - Computer Science Engineering
Kurukshetra University
Kurukshetra06.2009
Skills
- HIPAA
- Medicaid/Medicare
- Claims Adjudication
- Prior Authorization
- COB Policies
- EHR Systems
- Health Rules Payor
- MS Excel
- SOP Creation
- Process Optimization
Awards Recognitions
- Spot Award for exceptional performance in application design.
- Knowledge Management Award (2 times) for outstanding knowledge transfer.
Languages
English
Hindi
Punjabi
Certification
Licensed Pharmacy Technician, State of Georgia
Core Skills
HIPAA, Medicaid/Medicare, Claims Adjudication, Prior Authorization, COB Policies, EHR Systems, Health Rules Payor, MS Excel, Outlook, Data Entry, Scheduling, Documentation, SOP Creation, Process Optimization, Customer Service, Time Management, Critical Thinking, Multitasking, Team Collaboration
Timeline
Associate Business Consultant
Infosys Ltd.
04.2022 - 02.2025
Appeals Analyst
Delta Dental
09.2021 - 03.2022
Claims Business Analyst
Aliera Healthcare
07.2019 - 07.2021
Claims Analyst (Medicaid)
Gateway Health Plan
10.2018 - 06.2019
Associate Software Engineer
UnitedHealth Group
07.2011 - 04.2012
Bachelor of Technology - Computer Science Engineering
Kurukshetra University