Praveen Kumar

Results-oriented Senior Process Executive with extensive, proven expertise in the US Healthcare domain across multiple tier-1 organizations. Demonstrated proficiency in Quality Management methodologies, claims auditing, and driving strict compliance to elevate client satisfaction. Consistently recognized for operational excellence, team leadership, and timely delivery of complex workflows under tight timelines.

Senior Process Executive at Firstsource Solutions Pvt. Ltd. (2024-09 – Present)

• Adjudicate US-based health insurance claims within the Customer Server framework, ensuring strict security compliance via Citrix environments.
• Support multiple product tiers, including PPO, HMO, and EPO, with a core specialization in resolving complex Provider Dispute Claims.
• Utilize a specialized suite of industrial healthcare platforms including EZ-Cap, Macess, 3M Pricer, CMS Web Pricer, and Propharma.
• Execute end-to-end provider data management, troubleshoot application infrastructure anomalies, and update operational streams to prevent backlogs.

Senior Process Executive at Cognizant (2021-09 – 2022-10)

• Managed healthcare domain migrations by delivering critical Customer Information System (CIS) data required for seamless transitions into new provider contractual agreements.
• Maintained database integrity by updating complex provider rosters and systematically resolving edge-case provider queries.
• Issued and verified formal participation completions delivered directly to certified healthcare providers.
• Applied business process excellence and rigorous quality frameworks based on institutional guidelines to continuously maximize workflow efficiency.
• Provided Tier-2 application support to resolve end-user technical software issues and assisted in standardizing operations.
• Delegated team milestones, monitored daily workloads, and ensured strict alignment with corporate Service Level Agreements (SLA) and Turnaround Time (TAT) thresholds.

Process Executive at Hinduja Global Solutions (2019-06 – 2021-03)

• Managed end-to-end healthcare claim adjudication and processing workflows with high accuracy metrics.
• Leveraged advanced industry platforms such as the Claim Adjudication System (CAS) and Enterprise Financial Recovery System (EFRS) to process financial adjustments.
• Interfaced with clients and institutional customers to audit account metrics and resolve complex financial discrepancies.
• Provided prompt, high-quality resolutions to escalated consumer complaints, securing peak client satisfaction scores.

B.Sc. in Computer Science – Kongu Arts and Science College (Bharathiar University) (2018)

Higher Secondary Course in HSC – Mercy Matric Higher Secondary School (Tamil Nadu State Board) (2015)

Secondary School Leaving Certificate in SSLC – Mercy Matric Higher Secondary School (Tamil Nadu State Board) (2013)