Priyali Tambe

• Led FEP audit, producing a comprehensive claim-level report through collaboration with cross-functional teams, implementing inclusion logic for medical claims, optimizing rebate collection processes, resulting in a 20% reduction in monthly workload for 4 HCSC teams and contributing to saving $11 million.
• Oversaw the curation and posting of medical drug lists for TX and NM Department of Insurance websites, managing end-to-end processes, adapting to a one-week timeline, and pioneering the establishment of NM formulary, ensuring efficient data preparation and future publications
• Constructed a centralized master report consolidating line items from monthly vendor invoices, conducted a meticulous sanity check on Jan-Oct'23 backup detail, ensuring accuracy and addressing anomalies, while identifying and addressing gaps in invoice and admin fee backup details to enhance data quality and completeness.
• Linked HCSC and vendor programs, studied UM billing for 2023 by organizing data in a data dictionary, revealing information on review types and finding cases of double charges. Discovered that Non-Clinical Reviews, making up 6-11% monthly, could lead to higher costs in the future.

Client A (Reinsurance)

• Collaborated with client teams to execute 170+ identified use cases by creation of business rules to maintain data integrity for organizational domains such as finance, underwriting, & operations which increased process agility by 15%.
• Formulated an ad hoc lightweight data governance organization with business glossary, data catalogs using Collibra tool by validating data lineage, data quality to simulate a scalable environment.

Client B (Insurance)

• Developed and executed a repeatable system for identifying PI information across structured databases and devised a plan to deprecate it.
• Performed data ingestion by consolidating large volumes of structured data for a reinsurance firm and identified 900 billion PII based on data sensitivity, data flow, relevance, usage, and compliance to recommend risk mitigation areas.
• Implemented a "Cleanup Data Landscape (CUDL)" program as part of a data rationalization project, using large chunks of data to reduce risk exposure by generating interactive visualization dashboards utilizing PowerBI and Tableau for 30+ domains in scope.
• Maintained and updated the schema tracker with details and count of
  deprecated instances approved by client SMEs.
• Consolidated data in csv files using a Power BI dashboard, represented it in an executive dashboard, and managed dashboards for various AORs (Areas of Responsibility).
• Identified and remediated unsanctioned/unused data to enable cost reduction.
• Created a Center of Excellence to detect execution errors and helped build & maintain Knowledge Repository in SharePoint for data literacy campaign by documenting procedures which led to 10% increase in effective utilization of resources.