Ravindra D R

Results-driven healthcare professional with experience in customer service and Special Investigation Unit (SIU) operations. Proven ability to manage high-volume call environments, interact with members, providers, and third-party agents, and identify fraud, waste, and abuse (FWA). Strong analytical, communication, and compliance skills with focus on accuracy and operational excellence.

Customer Service Associate / SIU Support at Sagility India Pvt Ltd (2024-08 – Present)

• Handled 50+ inbound/outbound calls daily involving members, providers, and third-party agents with high customer satisfaction.
• Resolved complex inquiries related to claims, eligibility, benefits, and billing with accuracy and compliance standards.
• Supported SIU operations by identifying suspicious billing patterns and potential fraud, waste, and abuse (FWA).
• Performed preliminary investigation of claims and escalated high-risk cases for further SIU review.
• Collaborated with claims, compliance, and fraud investigation teams to ensure timely case resolution.
• Maintained strict adherence to HIPAA guidelines and data privacy regulations.
• Documented interactions, case notes, and investigation findings with a high level of accuracy.
• Consistently met quality and performance metrics in a fast-paced environment.

Bachelor of Computer Applications in BCA – Bangalore University