Shaji R

Results-driven US Healthcare RCM professional with 11+ years of experience across Accounts Receivable (AR), Denial Management, Claims Adjudication, Insurance Verification, Provider Revenue Cycle Operations, and Quality Auditing. Strong expertise in payer calling, appeals, underpayment analysis, claim lifecycle management, timely filing, COB resolution, Medicare/Medicaid guidelines, and aging AR reduction. Proven ability to improve claim resolution, support operational excellence, and collaborate with clients, vendors, and internal stakeholders.

Senior Process Executive at Cognizant Technology Solutions (2019-11 – Present)

• Performed denial analysis and AR resolution activities for US provider accounts.
• Investigated payment variances, reimbursement delays, claim denials, and account aging issues.
• Coordinated with business, client, vendor, and technical teams to resolve payment-related issues.
• Created and tracked production support tickets through JIRA for claim and payment resolution.
• Served as Quality Auditor for healthcare operations, ensuring adherence to process and compliance standards.
• Mentored team members and supported quality improvement initiatives.

Client Service Executive at Medusind Solutions (2018-05 – 2019-07)

• Conducted insurance eligibility and benefits verification with major US commercial and government payers.
• Verified coverage, limitations, authorizations, deductibles, co-insurance, and patient responsibility.
• Maintained 98%+ accuracy while documenting payer information and patient financial details.
• Reduced front-end claim rejections through accurate verification and documentation.

Senior Associate at Wipro BPS (2014-07 – 2018-03)

• Adjudicated complex hospital and physician claims using payer guidelines and business rules.
• Resolved claim denials involving timely filing, duplicate claims, COB, and eligibility issues.
• Reviewed appeals and provider resubmissions to ensure accurate reimbursement outcomes.
• Collaborated with AR teams to eliminate claim processing barriers and improve claim resolution.

Bachelor of Commerce in B.Com – Loyola College