Shubham Rajmane

Dynamic Strategic Advisor with 6+ years of experience in healthcare operations, claims adjustment analysis, and customer service within fast-paced environments. Proven ability to resolve complex healthcare issues, improving claimant satisfaction by 30% for Highmark Health Insurance. Highly skilled in medical claims analysis, settlement accuracy, and policy verification.

Passionate about enhancing patient outcomes by leveraging deep knowledge of healthcare systems and tools to drive operational efficiency.

Senior Representative Operations - CONCENTRIX IBM - Pune

(2017-08)

• Conducted outbound calls for Flipkart NDR (Non-Delivery Related) inquiries, ensuring proper address verification and rescheduling.
• Managed inbound logistics support for Flipkart Wishmaster, addressing discrepancies and executing pickup denial overrides.
• Delivered backend support for Highmark Health Insurance (Non-Voice Process), handling complex claims and settlements.
• Resolved provider issues, analyzed medical claims, and verified benefits and policy details.

Transaction Advisor – Highmark Health Insurance - CONCENTRIX IBM - Pune

(2021-02)

• Investigated and processed medical claims for U.S. clients.
• Analyzed settlement patterns and ensured compliance with insurance protocols.
• Acted as a liaison between internal departments and healthcare providers.

Wishmaster (Inbound Process) - CONCENTRIX IBM - Pune

(2020-05 - 2021-08)

• Addressed inbound courier-related queries.
• Collaborated with backend logistics to ensure smooth delivery resolutions.

Customer Support Associate - MINACS INDIA PVT LTD - Pune

(2016-06 - 2017-07)

• Handled telecom customer service queries and escalations effectively.
• Provided solutions for issues related to GPRS, VAS, and billing.

Bachelor of Arts - BA - YCMOU University (2016 - 2019)

HSC - Commerce - Jr. College Pune (2011 - 2013)

SSC - Sundarbai Marathe Vidyalay (2000 - 2011)