Pankaj Maske

International BPO Specialist with 8+ years of experience in business process management, US voice process, outbound AR calling, revenue cycle management, and insurance operations. Managed 500+ US voice interactions at 95%+ accuracy and full SLA adherence in a high-volume US shift environment, with a zero-escalation record across a 3-year engagement. Proficient in end-to-end US dental healthcare claims processing (200+ monthly), outbound AR calling (50+ daily calls), First Contact Resolution (FCR), Average Handle Time (AHT) optimization, denial management, and customer satisfaction improvement.

Backed by 3 years of US insurance domain expertise covering premium audit, NCCI and ISO classification, payroll compliance verification, fraud detection, and underwriting support. Committed to digital transformation and process excellence. Proficient in MedClarity, PremiumWare, Advanced Excel (Pivot Tables, VLOOKUP), CRM tools, Citrix, and VPN.

Career Break - Family Caregiving and Professional Development - Nagpur, Maharashtra

(2025-04)

Took a planned career break for family caregiving responsibilities, a personal commitment now fully resolved. Remained professionally active by completing IBM Artificial Intelligence Fundamentals, IBM AI for Customer Service, and Google Cloud Generative AI for Business certifications (2026).

Senior Phone Auditor - US International Voice Process and Insurance Audit Operations - Trivium Management Services Pvt. Ltd. - Nagpur, Maharashtra

(2022-04 - 2025-04)

• Managed 500+ US telephonic interactions and E-Audit sessions across 10+ US states in a high-volume outbound voice process on US shift, achieving 95%+ accuracy, 100% SLA adherence, and zero client escalations across the full 3-year tenure.
• Delivered compliance-led telephonic client interactions using targeted questioning techniques and active data collection, achieving consistent First Contact Resolution (FCR) and measurable customer satisfaction outcomes across diverse US business profiles.
• Optimized Average Handle Time (AHT) by 15% through outbound call workflow redesign and reusable documentation templates, improving daily throughput and team output capacity without compromising process adherence standards.
• Applied NCCI and ISO classification standards across US industry verticals including construction, healthcare, transportation, and manufacturing on live calls, ensuring regulatory-accurate data collection and precise risk categorization in every interaction.
• Built integrated performance dashboards using Advanced Excel (Pivot Tables, VLOOKUP) and PremiumWare, enabling real-time KPI tracking, TAT variance analysis, and capacity planning to support informed operational decisions.
• Acted as the primary escalation point for complex US voice interactions, trained junior associates on call quality and compliance standards, and standardized SOP documentation to drive team-wide process excellence and reduce error rates.
• Coordinated US insurance audit workflows across Workers Compensation, General Liability, and Auto Liability lines, handling voice interactions requiring real-time regulatory knowledge and live payroll data verification.

Client Service Executive - US Healthcare Claims Processing, AR Calling and Revenue Cycle Management - Medusind Solutions India Pvt. Ltd. - Ahmedabad, Gujarat

(2020-02 - 2022-03)

• Administered end-to-end adjudication for 200+ US dental insurance claims monthly through MedClarity, covering submission, denial management, appeals, and resolution while maintaining 100% HIPAA adherence and SLA standards.
• Improved first-pass claim acceptance rate by 20% by applying root-cause analysis to identify CPT coding errors, documentation gaps, and eligibility mismatches in rejected claims, then deploying structured pre-submission checklists that eliminated those failure points.
• Executed 50+ outbound AR calls daily to US carriers and payers in US shift operations, resolving adjudication disputes, reversing underpayments, and tracking aged receivable closures using aging reports as a reference baseline while sustaining 95%+ accuracy.
• Reviewed EOB documents and payer portal data to detect denials, underpayments, coordination of benefits errors, and billing discrepancies, initiating targeted appeals and resubmissions that maximized claim recovery and improved customer satisfaction outcomes.

Career Development Period - REDP Entrepreneurship Certification - Maharashtra Centre for Entrepreneurship Development (MCED) - Nagpur, Maharashtra

(2018-01 - 2020-01)

• Earned REDP certification (2019) with applied training in business planning, financial management, and regulatory adherence, bridging operational management experience into business operations.

Assistant Manager - Operations and Client Account Management - FoodbyMood - Nagpur, Maharashtra

(2014-12 - 2018-01)

• Oversaw onboarding and account management for 50+ business partners, resolving escalations, maintaining SLA-compliant service delivery, and driving 30% revenue growth through structured partner evaluation and cross-functional coordination.
• Achieved 25% improvement in partner satisfaction scores through systematic gap analysis of service delivery failures and targeted process corrections, establishing the escalation management and decision-making discipline carried across 8+ years of international BPO operations.

Higher Secondary Certificate - HSC - Maharashtra State Board (2006)

Secondary School Certificate - SSC - Maharashtra State Board (2004)