SANDEEP SHIRALI
Dayton
Summary
Accomplished professional with over 20 years of experience in healthcare eligibility, benefits, billing, and customer service for Middle Market, Key, and National accounts. Efficiently manages a high volume of cases while maintaining accuracy. Recognized for adaptability, creativity, and a results-driven mindset. Strong communication, organization, and problem-solving abilities contribute to delivering top-quality customer service to clients. Dedicated to making impactful contributions towards advancing organizational objectives.
Overview
18
18
years of professional experience
Work History
Senior Electronic Eligibility Consultant
Aetna, CVS Health Company
08.2023 - 11.2024
- Primary electronic eligibility consultant for National accounts for Plan Sponsors, TPA, and Vendors for Aetna Medical, Dental, and Vision products.
- Managed a book of business for National account clients with membership from 50,000 to 150,000 employees. Maintained accurate files and records while managing the day-to-day operation for my clients. Verified client’s member and dependent eligibility, coverage, and plans for different Aetna products that their employees selected in numerous Aetna eligibility systems and databases.
- Performed troubleshooting and technical support to ensure the success of Aetna customer service initiatives. Resolved customer complaints in an efficient and effective manner.
- Coordinated with different internal departments to set up a new database that listed employee information for all the clients handled by my team. It listed the employee’s enrollment, eligibility, and benefits that they selected for all of the Aetna products. This new database was accessed by sales, underwriting, plan setup area and other internal departments expediting response to client’s inquiries and also delivering excellent customer service to the clients.
- Reviewed, audited, and if needed updated eligibility and enrollment workstream transactions from beginning to end in Aetna’s Salesforce database. Primary contact for processing and auditing all open enrollment eligibility files for clients resulting in successful open enrollment process without any issues at Client’s renewal.
- Developed and implemented an audit system for teammates to use where the compare analysis for large databases was used. The customer’s employee database was analyzed and audited against Aetna member database every quarter to make certain that there were no discrepancies between the databases regarding employee coverage, plan, and eligibility for employee and dependents. This resulted in improved customer service and reduction in member eligibility errors as well as customer complaints.
Senior Plan Sponsor Service Consultant
Aetna, CVS Health Company
03.2007 - 08.2023
- Primary contact for Plan Sponsors, Brokers, and TPA for Select and Key accounts for eligibility, billing, enrollment, benefits, healthcare plans, ID cards, and billing setup for clients.
- Managed a book of business for select and key accounts with membership from 100 to 7000 employees. Received numerous Kudos and recognition from Directors, Account Managers, Brokers, as well as Plan Sponsors for excellent customer service to internal and external clients. Single point of contact for 80-90 clients. Handled all customer service inquiries regarding billing, benefits, preauthorization information, enrollment and eligibility for all my clients.
- Exceeded monthly quota routinely for debits and credits less than 60-day metric, non-admit metric and DSO for the past 15 years. Managed book of business that billed between 7-10 million a month to clients.
- Performed investigations, analysis, and development of solutions that are client specific to resolve internal and external problems.
Education
BS - Business Administration (Double Major-marketing/Management)
Bloomfield College
Bloomfield, NJDiploma - Mainframe Computer Programming
Chubb University
Diploma - Oracle DBA Programming
Rutgers Oracle University
Certificate - Project Management
Middlesex County College
Diploma - Medical Coding, Billing, and Medical Terminology
Alison.Com
Skills
- Analytical problem solving
- Effective multi-tasking
- Customer support and engagement
- Proficient in case and time management
- Effective communication
- Data-driven decision making
- Skilled in Microsoft Office applications
- Experience with various database management systems
- Proficient in enrollment systems: MEA, AAS, EEM, EOS, LGIT
- Knowledgeable in EHR software applications and integration
Accomplishments
Developed and implemented an audit system for teammates to use where the compare analysis for large databases was used. The customer’s employee database was analyzed and audited against Aetna member database every quarter to make certain that there were no discrepancies between the databases regarding employee coverage, plan, and eligibility for employee and dependents. This resulted in improved customer service and reduction in member eligibility errors as well as customer complaints
Received numerous Kudos and recognition from Directors, Account Managers, Brokers, as well as Plan Sponsors for excellent customer service to internal and external clients. Single point of contact for 80-90 clients.
Exceeded monthly quota routinely for debits and credits less than 60-day metric, non-admit metric and DSO for the past 15 years.
Languages
Hindi
Elementary
Marathi
Limited Working
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Software
Knowledge of databases -Salesforce, SQL, Share point, Oracle
Familiar with DB2 database
Proficient with Microsoft Products
Familiar with Project Management
Knowledge of Enrollment systems, MEA, LGIT, EEM, EOS, AAS
Familiarity with Epic, SAP
Work Preference
Work Type
Full TimeWork Location
RemoteImportant To Me
Work-life balancePaid time offHealthcare benefitsStock Options / Equity / Profit Sharing401k matchCareer advancementCompany CultureFlexible work hoursWork from home optionTimeline
Senior Electronic Eligibility Consultant
Aetna, CVS Health Company
08.2023 - 11.2024
Senior Plan Sponsor Service Consultant
Aetna, CVS Health Company
03.2007 - 08.2023
Diploma - Mainframe Computer Programming
Chubb University
Diploma - Oracle DBA Programming
Rutgers Oracle University
Certificate - Project Management
Middlesex County College
Diploma - Medical Coding, Billing, and Medical Terminology
Alison.Com
BS - Business Administration (Double Major-marketing/Management)
Bloomfield College
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