Prathyusha Gunturu
Wexford,USA
Summary
Wide range of duties for the business that company represent. This include providing information about product dealing with concerns and questions, reviewing customer accounts. Motivated to maintain customer satisfaction and contribute to company success. Proven ability to establish rapport with clients and exceed sales quotes. Reliable and driven, with strong time management and prioritization abilities and dealing with medical claims assists patients or healthcare providers in navigating the claims process, involved in appeals handles situations where claims are denied or disputed. They work to understand the reasons for denials, gather necessary documentation or information, and submit appeals on behalf of patients or healthcare providers and consumer experience in recent part time projects. I haven't added recent experience since 1 year as I was in part times self employment 1099 based CSR jobs and video editor experience for 2 years.
Document processing professional with solid foundation in managing and maintaining accurate records. Adept at collaborating with teams to ensure smooth workflow and timely completion of tasks. Recognized for adaptability and commitment to achieving high-quality results, contributing to overall team success.
Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Document Processor/Eligibility Specialist
AHS
Pittsburgh, PA
10.2024 - Current
- Managed multiple priorities effectively, often working on several projects simultaneously while meeting all deadlines.
- Participated in regular team meetings to discuss ongoing projects and address any challenges or areas for improvement.
- Conducted thorough quality checks on completed documents, maintaining an exceptional level of accuracy and attention to detail.
- Maintained strict confidentiality when handling sensitive information, adhering to company policies and regulations at all times.
- Streamlined workflow for faster document processing, leading to improved productivity and time management.
- Provided assistance with inbound and outbound document processes, document sorting, logging, and work order creation.
- Accurately processed a high volume of documents within strict deadlines, ensuring timely delivery to clients.
- Adapted quickly to new software programs introduced into the workplace, minimizing disruption to existing workflows.
- Converted documents from one application to another.
- Maintained up-to-date knowledge of relevant laws, regulations, and policy changes affecting Medicaid eligibility determinations.
- Improved customer service experience for applicants, providing clear explanations of eligibility requirements and addressing concerns promptly.
- Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
- Worked effectively in fast-paced environments.
- Excellent communication skills, both verbal and written.
- Resolved customer inquiries and complaints from multiple channels with moderate supervision.
- Utilized time management strategies effectively while working remotely, balancing workload demands with personal responsibilities at home.
Benefits Specialist
ibex Global
Pittsburgh, PA, US
08.2023 - 10.2024
- Provided exceptional customer service by promptly addressing inquiries, resolving issues, and ensuring customer satisfaction
- Maintained a high level of product knowledge to effectively assist customers with their questions and concerns
- Managed a high volume of incoming calls and emails, consistently meeting or exceeding response time goals
- Resolved customer complaints in a professional manner, finding appropriate solutions to ensure customer loyalty
- Collaborated with cross-functional teams to escalate complex issues and provide timely resolutions for customers
- Implemented new strategies to improve the overall customer experience, resulting in an XX% increase in customer satisfaction ratings
- Developed strong relationships with key clients through regular communication and personalized support
- Recognized as top performer within the team for consistently achieving high levels of customer satisfaction scores above 96%
- Collaborated with the sales team to identify upselling opportunities during interactions with customers, contributing to an increase in average order value by 98%
- Provided compassionate care to patients by addressing their concerns and providing clear instructions regarding medications and follow-up appointments
- Collaborated with healthcare team members to coordinate referrals for specialty care services based on individual patient needs
- Managed patient flow in a fast-paced environment, ensuring minimal wait times and efficient use of healthcare providers' time
- Participated in team meetings to discuss process improvements, address challenges, and implement best practices for enhanced patient care delivery
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
- Maintained compliance with federal regulations regarding FMLA, ADA, and other relevant laws governing employee benefits.
- Participated in annual benefit plan review meetings with senior leadership, providing data-driven insights and recommendations for future plan design adjustments.
Quality Assurance Engineer
Mortgage Connect
Pittsburgh, PA, US
01.2019 - 03.2023
- Used Agile methodology in developing the Web applications and desktop based
- Responsible for providing Risk Assessments, test Plans, test cases and executing and creating test results within an AGILE software development SCRUM environment
- Preparation /Review of Test Strategy, Test Plan and Estimations
- Responsible with manual testing process and selenium skills
- API Testing manually and automated through Postman also use SAGE tool for accounting purposes
- Defect Reporting, Analysing, Tracking and Report Generation using Jira/AZure
- Worked on SQL database using SQL Server Management
- Worked on Technical documentation, e.g
- Test plans, test cases and test scripts, test reports and trace matrix
- Logging in the bugs in the JIRA and tracking them daily for proper closure
- Worked on Accessibility testing using assistive technologies such as screen readers, magnifiers and keyboard-only navigation to test the software accessibility
- Core java development for different components
- Developed the application using Core Java, Multi-Threading, Collections in abundance, REST for backend APIs, My SQL as DB server, Maven
- Developed automated scripts for performing Regression Testing through Selenium WebDriver
- Extensively used Selenium (data-driven, XPath locator) and Selenium WebDriver to test the web application
- Responsible for implementation of Hybrid Test Automation Framework build using Selenium, JUnit, Behave, Maven, cucumber and Jenkins Java platform utilizing industry-leading harness design patterns and approaches
- Developed Test Scripts to implement Test Cases, Test Scenarios, and features for BDD (Behavior Driven Development), TDD (Test Driven Development) using Cucumber with java
- Test automation for web application (SWAP module) using Cucumber
- Involved in developing automated test cases using Cucumber in JUnit
- Automation project setup and deployment in Jenkins for continuous Integration (CI)
- Used Maven for Project build management
- Design and develop the processes using multithreading to make it asynchronous
- Built custom advertising tool/store using JavaScript
- Developed automated test scripts using TestNG annotations like Group, parameter, Data provider
- Configured the Test Cases to receive input Test Data Sets for the corresponding test cases using TestNG Data Provider Annotation
- Performed regression testing and automation of testing process in White box testing
- Testing REST API's for all of the given web service requirements in the project
- Thoroughly tested RESTful API for XML & JSON responses while comparing the Database Tables
- Creating Web Services/XML testing on different Core applications using SOAPUI and Rest API
- Tested the SOAPUI Web services for Provider and Member portals
- Analyzing and Tested Rest based webs services using Soap UI
- Developed scenario based testing for the JMeter scripts
- Create, schedule and run the scenarios using JMeter and generate necessary graphs Used GIT for version control
- Role: QA/ Selenium Tester
Customer Service Representative
Conduent
Cary, NC, US
12.2017 - 07.2018
- Resolves Medical claims by approving or denying documentation and calculating benefit due
- Handle inquiries both telephonically and by email
- Create and update SharePoint pages
- Knowledge of CPT, ICD-P AND ICD-10 codes Resolve pharmacy issues from members, providers and pharmacies, determine the cause of the issue; select and explain the best solution to solve the issue; expedite correction or adjustment; follow up to ensure resolution
- Respond to routine inquiries on multiple products from members, providers, pharmacies, and employer groups
- Research required information using available resources
- Route calls to appropriate resource
- Enter data accurately and timely
- Maintain confidentiality of patient and proprietary information
- Researched and resolved pending cases within a timely manner
- Assist customers with queries on their health care benefit accounts and providing customer satisfaction
- Handling the enquiries from customers
- Provide assistance to customers who had disputes on the billing and dealing with medical claims assists patients or healthcare providers in navigating the claims process
- Involved in appeals handles situations where claims are denied or disputed
- They work to understand the reasons for denials, gather necessary documentation or information, and submit appeals on behalf of patients or healthcare providers
Process Associate
Synchrony financial GE capital
Hyderabad, Telangana, India
03.2016 - 09.2017
- Prepare financial and credit information to streamline and providing personal financial counselling assist with credit cards and building relationships with existing customers to sustain high satisfaction ratings and retention
- Assist customers with account application process and involved in appeals handles situations where claims are denied or disputed
- They work to understand the reasons for denials, gather necessary documentation or information, and submit appeals on behalf of patients or healthcare providers
- Involving enrollments focus on assisting individuals or groups with enrolling in healthcare plans, such as medical insurance or dental plans
- This includes explaining plan options, benefits, and costs, assisting with enrollment forms or applications, verifying eligibility, and addressing enrollment-related inquiries or issues
- Assisted senior video editors in the editing and post-production of various video projects
- Applied color correction, audio enhancement, and visual effects to enhance overall quality of videos
- Worked closely with clients to understand their vision and incorporate feedback into final edits
- Provided technical support during live streaming events or virtual meetings by operating cameras or switching between camera angles smoothly
Data Analyst
Google Inc
Hyderabad, Telangana, India
04.2015 - 02.2016
- Successfully interpreted data to draw conclusions for managerial action and strategy
- Used statistical techniques for hypothesis testing to validate data and interpretations
- Optimized data collection procedures and generated reports on weekly, monthly and quarterly basis and involving enrollments focus on assisting individuals or groups with enrolling in healthcare plans, such as medical insurance or dental plans
- This includes explaining plan options, benefits, and costs, assisting with enrollment forms or applications, verifying eligibility, and addressing enrollment-related inquiries or issues
- Edited and produced high-quality videos for various clients, including commercials, promotional videos, and social media content
- Optimized video files for different platforms (e.g., YouTube, Instagram) by adjusting resolution, aspect ratio, file size/compression without compromising quality
- Incorporated motion graphics and visual effects to enhance the overall production value of videos
Education
Bachelor of Science - B Pharmacy
Jawaharlal Nehru Technological University
Hyderabad, Telangana08.2014
Diploma in Aviation -
NIIT
Hyderabad, Telangana01.2009
Skills
- Computer skills
- Java
- API
- Customer service
- Time management
- Selenium
- Software testing
- Test Cases
- Sales
- Call Center
- Git
- Driving
- ICD coding
- CSR
- SharePoint
- Loan processing
- Communication skills
- Loan origination
- Microsoft SQL Server
- 10 key typing
- MySQL
- XML
- Information security
- Hot stone massage
- Financial services
- Server management
- Desktop administration
- Consumer experience
- Typing
- Microsoft Office
- Trigger point therapy
- REST
- SQL
- Agile
Certification
- Life & Health Insurance License
- CPR Certification
Personal Information
Authorized To Work: US
Languages
Telugu
Native or Bilingual
Hindi
Professional Working
Timeline
Document Processor/Eligibility Specialist
AHS
10.2024 - Current
Benefits Specialist
ibex Global
08.2023 - 10.2024
Quality Assurance Engineer
Mortgage Connect
01.2019 - 03.2023
Customer Service Representative
Conduent
12.2017 - 07.2018
Process Associate
Synchrony financial GE capital
03.2016 - 09.2017
Data Analyst
Google Inc
04.2015 - 02.2016
Bachelor of Science - B Pharmacy
Jawaharlal Nehru Technological University
Diploma in Aviation -
NIIT