Suffi Shabnam

Experienced healthcare professional with 7+ years of combined clinical and nonclinical expertise across physiotherapy, clinical investigation, and fraud control within health insurance. Skilled in fraud analytics, claims adjudication, provider billing review, and US healthcare coding (CPT/HCPCS). Proven ability to detect suspicious claim patterns, lead investigation teams, and reduce financial leakage, escalation management, and data-driven decision making.

Manager in Fraud control unit - Care Health Insurance (CHI)

(2023-02 - 2024-12)

• Investigated high-risk claims and identified suspicious billing patterns.
• Led team of investigators improving fraud detection efficiency.
• Reduced claim leakage through proactive review & escalation.
• Strengthened provider audit accuracy

Clinical Investigator - UnitedHealth Group (UHG)

(2021-05 - 2023-02)

I worked as clinical investigator and was responsible for approving/ denying medical claims. I worked on Excel, edge, and many other tools also work on Cpt, hcpc codes to process claims. My work was to read the medical file of patient submitted and decide accordingly services provided to the patient and pass or deny the claim amount. Also work on to reduce fraudulent claims submitted by the provider.

Physiotherapist - GWS physio care

(2019-12 - 2021-04)

Physiotherapist - HCAH

(2018-07 - 2019-11)

Career break - Planned career break

(2025-01)

Took Intentional pause to focus on full time care giving. Undertook structured learning in AI – exposure to practice AI application.

Masters - Physiotherapy (musculoskeletal) - MRIIRS (2018)

Bachelor - Physiotherapy - Manav Rachna International University (2015)