Shaik Vaseem

Detail-oriented Healthcare Operations professional with 3+ years of experience in U.S. healthcare claims adjudication, audit support, quality checks, and compliance-driven operations. Experienced in Medicare & Medicaid claims processing, ICD-10/CPT/HCPCS coding validation, payer guideline review, and HIPAA compliance. Contributed to audit readiness, QA processes, and regulated healthcare workflows.

Proven ability to perform buddy audits, onshore audit sheet reviews, root cause analysis, and payment integrity checks across high-volume environments.

Healthcare Operational Analyst at NTT DATA (2024-09 – Present)

Project Experience – Centene Corporation

• Handled U.S. healthcare claims and correspondence workflows with a focus on accuracy and compliance.
• Reviewed claims data for alignment with payer guidelines, SOPs, and audit requirements.
• Maintained audit-ready documentation, tracking, and reporting of claims-related activities.
• Identified claim discrepancies, performed root cause analysis, and escalated per defined protocols.
• Achieved productivity and quality benchmarks in high-volume claims operations.
• Supported data integrity reviews and quality audit checks on processed claims.

Healthcare Claims Analyst at Optum (2022-08 – 2024-09)

Project Experience – UnitedHealth Group

• Performed end-to-end Medicare & Medicaid claims adjudication based on payer guidelines and policies.
• Reviewed claims for ICD-10, CPT, HCPCS, and revenue code accuracy, eligibility, and benefit coverage.
• Performed internal audit and quality checks on U.S. healthcare claims and onshore audit sheets.
• Conducted buddy audits and reviewed claims for accuracy, compliance, and process adherence.
• Handled denial analysis, claim edits, payment discrepancies, and reprocessing workflows.
• Supported payment integrity, reporting, audit activities, and root cause analysis.
• Maintained HIPAA compliance, QA standards, and high productivity in a regulated environment.
• Collaborated with internal teams to resolve complex claims and improve process efficiency.

Bachelor of Commerce in B.Com – Osmania University (2018)