Vetri Kumaran

Healthcare professional with robust background in medical claims analysis and resolution. Adept at streamlining claim processing workflows and ensuring adherence to industry regulations. Valued team player with focus on collaboration and achieving optimal results, exhibiting flexibility to adapt to evolving demands. Proficient in medical coding, data analysis, and regulatory compliance, showcasing reliability and results-driven mindset.

Acted as a primary client contact for US health insurance accounts, managing day-to-day communication, issue resolution, and service delivery expectations

Served as a Subject Matter Expert (SME) in US Health Insurance, including claims processing, eligibility, enrollment, benefits, and provider operations

Coordinated with internal operations, quality, compliance, and IT teams to ensure seamless execution of client requirements

Translated client needs into operational workflows, SOP's, and process guidelines for internal teams

Monitored daily operations, productivity, and quality metrics to ensure adherence to SLAs and compliance standards

Conducted root cause analysis for operational issues and implemented corrective and preventive actions

Trained, on-boarded, and mentored new employees, ensuring strong understanding of US healthcare processes and client- specific requirements

Developed and updated training materials, process documentation, and knowledge base content

Performed quality reviews and audits to ensure compliance with HIPAA and payer-specific guidelines

Supported management with reports, client reviews, and process improvement initiatives

B.Sc Computer Science