Abdur Rahman

Results-driven healthcare operations professional with 5+ years of experience in US payer claims (Centene/Health Net). Proven expertise in claims adjudication, audit, compliance, and payment integrity. Strong track record of achieving >98% quality, meeting SLAs, and driving operational efficiency using automation and analytics tools.

Senior Process Executive - Cognizant India Pvt Ltd

(2021-01)

• Processed 80–120+ claims/day with >98% accuracy, ensuring SLA adherence and compliance
• Performed end-to-end adjudication using CPT/ICD-10 coding and eligibility validation
• Managed prior authorizations and MHN (behavioral health) claims, reducing denial rates
• Handled denials, appeals, and reprocessing using ANSI codes (CO/OA), improving recovery turnaround by ~20%
• Ensured billing compliance including Prop 56 and PPG coordination for accurate reimbursements
• Conducted audit reviews achieving >98% quality score and ensuring regulatory compliance
• Prepared daily and weekly reports tracking TAT, accuracy, and productivity metrics
• Investigated discrepancies and potential fraud cases in collaboration with stakeholders
• Utilized Facets, Macess EXP, Burgess, ABS tools for claims processing and audit tracking
• Improved efficiency by ~15% using automation and rule-based validation

Executive Operations - Aegis Customer Support Services

(2020-01 - 2021-01)

• Handled 60+ calls/day maintaining >95% CSAT and quality scores
• Resolved customer complaints and escalated complex issues
• Generated weekly reports using Excel for management review
• Recognized for consistent high performance and reliability

B.Sc - Computer Science - VIT University (2017-01 - 2020-01)