Vaibhav Patane

Results-driven Healthcare Claims Professional with 14 years of extensive experience in Medicare, Coordination of Benefits (COB), and Health Rules Payor (HRP). Proven expertise in managing complex healthcare claims, resolving escalations, maintaining quality standards, and supporting operational excellence. Demonstrated ability to mentor team members, improve process efficiency, and contribute to organizational goals.

Strong leadership, analytical, and communication skills with a commitment to delivering high-quality outcomes in fast-paced healthcare operations environments.

Senior Claim Processor Executive – HRP at Sagility India Pvt. Ltd. (Present)

• Process and adjudicate complex, high-value, and high-risk healthcare claims while ensuring accuracy and compliance.
• Investigate and resolve escalated claims within established turnaround times (TAT).
• Support team members by providing guidance on process-related issues and claim adjudication.
• Ensure adherence to quality standards, client requirements, and regulatory guidelines.
• Collaborate with internal stakeholders to improve operational performance and claim resolution efficiency.
• Contribute to achieving departmental productivity, quality, and service-level targets.
• Consistently achieved and maintained high productivity and quality scores.
• Recognized for effective handling of critical and complex claim scenarios.
• Played a key role in minimizing escalations through timely and accurate claim resolution.

Claim Processor – Medicare / COB at Sagility India Pvt. Ltd.

• Process Medicare and Coordination of Benefits (COB) claims with a high level of accuracy and attention to detail.
• Review claim information, identify discrepancies, and ensure appropriate claim adjudication.
• Support daily operational requirements and assist in maintaining workflow continuity.
• Participate in process improvement initiatives to enhance quality and operational efficiency.
• Ensure compliance with healthcare regulations, client policies, and internal procedures.
• Maintained excellent quality and productivity performance metrics.
• Developed strong domain expertise in healthcare claims processing.
• Contributed to process optimization and operational effectiveness.

Bachelor of Commerce in B.Com