Senior Process Executive (SPE) at Cognizant Technology Solutions (2023-07 – 2026-07)
Health care - Health net medical claims. Team: claim adjudication (facility team)
- Verified member, provider, insurance, and payment details to ensure accurate claim adjudication.
- Reviewed claim documentation and validated member eligibility, policy coverage, address, tax ID, and payment information.
- Utilized ABS, Macess, Burgess, and HealthSource applications for claims processing and adjudication activities.
- Retrieved and analyzed claim documents through Macess for claim determination.
- Processed claim approvals, denials, and payment decisions based on plan benefits and payer guidelines.
- Finalized claims in Burgess and HealthSource while maintaining quality and turnaround time standards.
- Collaborated with providers and internal teams to resolve claim-related discrepancies and ensure accurate claim outcomes.
- Worked as a Claims Adjudicator handling Medicare, Indemnity, and Commercial healthcare products including PPO, POS, and HMO plans.
- Reviewed and processed medical claims in accordance with payer policies, benefit plans, and adjudication guidelines.
- Ensured accurate claim adjudication while maintaining established Turnaround Time (TAT) standards to prevent interest payments.
- Investigated claim discrepancies and performed benefit validation to ensure proper claim resolution.
- Managed claim cases for Medicare and Commercial lines of business with a focus on quality and productivity targets.
- Provided cross-functional support to multiple teams, including HMO operations, to meet business requirements.
- Maintained compliance with healthcare regulations, client guidelines, and internal quality standards.
- Collaborated with internal stakeholders to resolve claim-related issues and improve operational efficiency.
Senior Process Executive (SPE) - Medicare Burndown Project at Cognizant Technology Solutions (2023-07 – 2026-07)
Project: Medicare Burndown
- Worked on Medicare Burndown processes involving Accum Engine 2.0 validation and reconciliation activities.
- Reviewed benefit packages and Date of Service (DOS) to identify discrepancies in member accumulators and out-of-pocket amounts.
- Handled excess amount investigations across multiple vendors, including PPG, MHN, ASH, and Pharmacy.
- Coordinated with vendor teams by raising requests and obtaining copay reports for reconciliation.
- Compared vendor reports with OOPM (Out-of-Pocket Maximum) sheets and performed necessary adjustments.
- Monitored updates in Accum Engine 2.0 to ensure successful reflection of adjustments.
- Maintained and updated onshore manual trackers for unresolved excess amounts.
- Collaborated with IT teams to investigate and resolve accumulator discrepancies and excess amount issues.
- Ensured data accuracy and timely resolution while meeting quality standards.
Senior Process Executive (SPE) - Marketplace Burndown Project at Cognizant Technology Solutions (2020-02 – 2022-12)
Project: Marketplace Burndown
- Worked on Marketplace Burndown processes involving accumulator reconciliation and excess amount resolution.
- Utilized OOPM (Out-of-Pocket Maximum) sheets to validate threshold amounts and identify accumulator discrepancies.
- Used Golden 7 application to review member accumulators, stop-loss details, and excess amounts.
- Analyzed member benefit packages and coverage limits through ServiceX.
- Investigated excess accumulator amounts and performed root cause analysis.
- Coordinated with vendor teams including AMI, Pharmacy, and PPG for timely resolution of excess amounts.
- Prioritized excess resolution activities based on business requirements and impact analysis.
- Ensured accurate updates to member accumulators and compliance with benefit plan guidelines.
- Collaborated with internal and external stakeholders to resolve discrepancies and improve data accuracy.
Associate at Wipro Technologies CDC 5 SEZ (2020-02 – 2022-12)
Roles and Responsibilities: Loan Processing & Mortgage Operations
- Coordinated loan documentation and processes between onshore clients and borrowers.
- Reviewed loan files, conversation logs, and supporting documents to facilitate appraisal, title, fraud, and verification orders.
- Retrieved and indexed documents from File Manager into designated folders for efficient document management.
- Processed payoff statements for multiple states including Texas (TX), Florida (FL), and Maryland (MD).
- Ensured accuracy and completeness of loan documentation while meeting turnaround time requirements.
Associate - Freedom Mortgage Closing at Wipro Technologies CDC 5 SEZ (2020-02 – 2022-12)
Freedom Mortgage Closing
- Reviewed Closing Instructions and Docs Out packages for mortgage closing transactions.
- Verified closing dates, disbursement dates, first payment dates, borrower information, and closing disclosures.
- Validated payoff, insurance, and tax-related documents using Sagent, EDMS, and Lakewood systems.
- Reviewed cash-to-close calculations, lender credits, and borrower disbursement details for accuracy.
- Uploaded closing documents to EDMS and Keystone systems and ensured compliance with closing requirements.
- Compared Final Draft Closing Disclosure (CD) with Keystone CD and verified all borrower and loan information.
- Added applicable state-specific forms and prepared final closing document packages.
Associate - Discover Mortgage Servicing at Wipro Technologies CDC 5 SEZ (2020-02 – 2022-12)
Discover Mortgage Servicing
- Supported mortgage servicing operations by reviewing, organizing, and stacking required loan documents.
- Coordinated with banks and borrowers to obtain missing documentation and ensure file completeness.
- Maintained document accuracy and compliance with servicing requirements.
