Summary
Overview
Work History
Education
Skills
Timeline
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Sangeetha Sulake

Frisco,TX

Summary

  • Overall 5+ years of Claims Specialist (SME) and trusted advisor skilled in research, analysis and examination of company technology and standard operating procedures.Interface and collaborate with clients and internal team members, providing consultative enhancement recommendations based on industry research.Improve existing processes, procedures, technical enhancements, resource requirements and stakeholder engagement procedures to align with strategic goals.
  • Dependable professional with success in field, attention to detail and proactive mindset. Seeks opportunities to improve processes and workflows for team benefit. Conscientious, hardworking and excels at multitasking in fast-paced environments.

Overview

12
12
years of professional experience

Work History

Claims Specialist (SME)

Atos
Irving, Texas
02.2022 - 04.2023
  • Provided subject matter expertise and guidance to cross-functional teams in the development.
  • Drafted technical documents, such as user manuals and training materials, to ensure accuracy of content.
  • Mentored junior staff members on best practices related to project and implementation strategies.
  • Managed customer inquiries with a focus on providing timely resolutions while maintaining excellent customer service levels.
  • Identified areas of risk within complex projects then proposed mitigation strategies for successful completion of tasks.
  • Facilitated workshops with internal stakeholders in order to gather feedback regarding product performance issues or enhancements.
  • Data entry of client information into several designated databases Record System.
  • Processing and tracking inpatient and outpatient authorization requests.
  • Processing high volume inpatient and outpatient authorizations within established turnaround times and serving as back up for other Clinical Administrative Coordinator processes depending on staff availability.
  • Performed quality assurance testing on prototype designs prior to production release in order guarantee functionality upon delivery.

Claims Specialist (SME)

Cognizant Technologies Solutions
Hyderabad, INDIA
06.2014 - 02.2017
  • Conducted internal audits of production facilities to ensure compliance with safety regulations and industry standards.
  • Reviewed customer feedback data to identify areas for improvement in product design and development.
  • Monitored performance metrics to assess the effectiveness of quality control initiatives.
  • Managed a team of Quality Analysts and provided guidance on best practices for testing protocols.
  • Performed root cause analysis of reported defects and developed corrective action plans accordingly.
  • Collaborated with cross-functional teams such as Engineering, Product Development, and Operations to ensure product quality goals were met.
  • Trained new Quality Analysts on established procedures and techniques used in assessing product quality.
  • Implemented changes based on customer feedback to improve overall satisfaction with products.
  • Managed planning, balancing and delegation of testing work.
  • Maintained quality assurance procedure documentation.

Claims Associate

United Healthcare Group
Hyderabad, INDIA
11.2010 - 03.2012
  • Assessed claims to determine validity and appropriateness of coverage according to policy guidelines.
  • Conducted research on claim issues, utilizing available resources such as databases and other documentation with Medicare and / or Medicaid Services.
  • Analyzed data and formulated decisions regarding the approval or denial of claims with ICD-10 and CPT codes.
  • Developed strategies for resolving complex cases, including those involving multiple parties or high-value items.
  • Reviewed medical records and documents submitted by claimants to ensure accuracy and completeness of information provided.
  • Processed payments for approved claims in a timely manner, adhering to established payment schedules and procedures.

Education

Bachelor of Science -

St. Anns Degree College
Osmania University
07-2009

Skills

  • Strategic Thinking
  • Research capabilities
  • Strong analytical skills
  • Project Planning
  • Team Collaboration
  • Data Analysis
  • Multitasking
  • Time Management

Timeline

Claims Specialist (SME)

Atos
02.2022 - 04.2023

Claims Specialist (SME)

Cognizant Technologies Solutions
06.2014 - 02.2017

Claims Associate

United Healthcare Group
11.2010 - 03.2012

Bachelor of Science -

St. Anns Degree College

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Sangeetha Sulake