Shumaila Punjani

• Designed, developed, and maintained custom WordPress websites for small businesses using Elementor Pro and Bluehost hosting, improving online presence and user experience.
• Partnered with clients to gather requirements, analyze business needs, and translate objectives into functional, user-focused website solutions.
• Managed multiple projects concurrently, overseeing project timelines, content updates, design enhancements, and stakeholder communications to ensure successful delivery.
• Conducted website performance analysis using Google Analytics and Google Tag Manager, providing insights and recommendations to support optimization efforts.
• Leveraged AI-powered tools, including ChatGPT, Microsoft Copilot, and Claude, to enhance research, content development, documentation, and overall project efficiency.
• Delivered ongoing technical support, troubleshooting, and website enhancements, maintaining high levels of client satisfaction and long-term engagement.
• Pursued continuous professional development in business analysis, Agile methodologies, process improvement, and emerging technologies to strengthen analytical and technical capabilities.

• Led end-to-end business analysis activities for workflow automation and digital transformation initiatives, partnering with stakeholders to define requirements and deliver scalable solutions.
• Elicited, analyzed, and documented business requirements, user stories, acceptance criteria, process flows, and functional specifications for Agile development teams.
• Acted as the bridge between business and technology teams, ensuring stakeholder needs were clearly understood, prioritized, and translated into actionable development work.
• Facilitated backlog grooming, sprint planning, and feature prioritization sessions, helping teams deliver high-value solutions aligned with strategic objectives.
• Collaborated with QA teams and business users to develop test scenarios, support system validation, and coordinate successful UAT execution.
• Developed stakeholder communications, training materials, release documentation, and user guides to support implementation, adoption, and change management efforts.
• Analyzed business processes and system performance to identify operational efficiencies, workflow improvements, and product enhancement opportunities.
• Supported post-production operations by monitoring application performance, resolving issues, and partnering with cross-functional teams to drive continuous improvement.

Lead Program Coordinator

• Led operational programs and workflow initiatives, ensuring efficient execution of business processes and alignment with organizational goals.
• Utilized performance metrics, reporting tools, and KPI dashboards to analyze trends, measure outcomes, and support strategic decision-making.
• Partnered with leadership and cross-functional teams to identify operational challenges, recommend process improvements, and implement effective solutions.
• Served as the primary escalation point and subject matter expert for complex operational issues, driving timely resolution and minimizing business impact.
• Developed process documentation, standard operating procedures, and training materials to improve consistency, compliance, and team effectiveness.
• Facilitated onboarding and training programs, equipping new employees with the tools, systems knowledge, and process understanding needed for success.
• Supported continuous improvement initiatives through workflow analysis, stakeholder collaboration, and performance monitoring.
• Communicated program status, operational insights, and improvement recommendations to leadership and key stakeholders.

• Managed and processed prior authorization requests in accordance with healthcare regulations, organizational policies, and service-level requirements.
• Analyzed authorization and claims data to ensure accuracy, identify discrepancies, and support informed decision-making by leadership.
• Developed and maintained reports for senior management, providing operational insights, performance metrics, and trend analysis.
• Investigated and resolved complex claims inquiries and authorization issues by collaborating with internal teams, providers, and external stakeholders.
• Coordinated with healthcare providers and care teams to facilitate seamless patient care transitions and ensure timely authorization approvals.
• Maintained data integrity across claims and authorization systems through detailed validation, quality reviews, and process compliance monitoring.
• Identified process inefficiencies and contributed to workflow improvement initiatives that enhanced operational effectiveness and service quality.
• Supported cross-functional teams by providing subject matter expertise on authorization processes, claims procedures, and system functionality.

• Reviewed and processed medical claims in accordance with healthcare policies, provider contracts, and organizational guidelines to ensure accurate and timely adjudication.
• Analyzed claims data, member eligibility, and reimbursement information to validate payment accuracy, identify discrepancies, and support effective claims resolution.
• Applied ICD-9, CPT, and HCPCS coding knowledge to evaluate claim submissions, determine coverage, and ensure proper claim adjudication.
• Investigated and resolved claims issues by conducting detailed research, interpreting policy provisions, and collaborating with internal stakeholders.
• Maintained compliance with healthcare regulations, contractual requirements, and internal quality standards while meeting productivity and accuracy goals.
• Performed data validation and quality reviews to ensure data integrity and minimize processing errors.
• Identified trends and recurring issues within claims workflows, contributing to process improvements and operational efficiency initiatives.
• Leveraged analytical and problem-solving skills to support accurate claims processing and enhance overall service delivery.