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ASHISH RATHORE

Objective & Self Reflection::

      Seeking a position in your esteemed organization to utilize the skills I have developed during my career, with an eventual goal of assuming responsibilities and proving myself as a valuable asset to the organization.

 

      I believe that logical thinking and leadership qualities are my greatest possession. Ability to deal with people, the ability to grasp things fast, and willingness to work has always been my strengths.

:: “ Hard work pays ” ::

 

 

 

 

 

 

 

 

 Email:

aasshish2001@yahoo.co.in

 

 Mobile No.:

9818566558

 

Phone:

®  011-9250700202

Contact Address:

E-2/95 Street#3

Shastri Nagar

Delhi-110052

Permanent Address:

E-2/95 Street#3

Shastri Nagar

Delhi-110052

Personal Data:

Sex: Male

Nationality: Indian

Marital Status: Married

DOB: 31/03/1983

 

Languages Known:

  •     English
  •     Hindi

 

Passport:

Valid Indian passport

 

Work Experience:

6 yrs+ total experience

 

 

ducational Qualifications ::

1.      B (com) from Delhi University.

 

2.      PGDBA(Finance) from Symbiosis in 1st division (A+ Grade)

 

Brief Description::

Proactive and result- oriented with experience in aspects of insurance and Operation management. Solid planning and organizational skills in coordinating aspects Operations functions. Well disciplined with proven ability to manage multiple assignments efficiently under extreme pressure while meeting tight deadline schedules. Strong team builder and facilitator, which encourages team to perform efficiently. Effectively communicates direction, commits people to action, and conveys complex information in easily understood formats.

 

Strength::

1. Responsible for reviewing, auditing, and processing healthcare claims.

2.    Leadership.

3.    Process Improvement.

4.    Consistently adhering to processes and achieving desired results.

5.    Independently handled Team’s affairs with a high level of proficiency & integrity

6.   MIS making

Professional Experience ::

 

*      Company Name: IBM Global Process Services Pvt Ltd

·                     Position:  Senior Practitioner (NCO)

·                     Duration: September 2005–till date

·                     Location: Gurgaon

 



 

History At :IBM GPS Pvt Ltd.

 IBM GPS deliver asset-based business process outsourcing solutions to more than 75 clients across multiple industries globally.  IBM GPS is a leading global provider of innovative business process services for clients seeking to cut costs, improve operation efficiency and take advantage of the opportunities in the global economy.  Our network of delivery centers comprises offshore centers in India and Philippines and is further supported by IBM’s global delivery network of 50+ centers. 

 http://www-935.ibm.com/services/in/gts/bus/html/daksh_vision.html

 

Project Experience At: IBM GPS Pvt Ltd.

  1. Duration: September – 2005 to Till Date

 

a.       Position                      : Senior Practitioner, CRM-Operations

b.       Location                     : Gurgaon

c.      Responsibility                :  Claims auditing, Process training, Medical bills processing, report publishing,

 

 

Job Responsibilities     :-

      Claim auditing and team support:-

  • Responsible for reviewing, auditing, and processing healthcare and medical claims/billing information. This position involves billing and auditing one or more of the following claims types: Outpatient (UB92), Inpatient (UB92) and/or Physician (HCFA) claims.
  • Checks the eligibility submitted through electronic form, check for contracted rates verify the ICD9 codes, procedure codes, diagnosis.  Claim Auditing for multiple health care specialties, places of service, benefit and plan types inclusive of both core medical and ancillary care services.
  • Experienced in handling complex claims, possess strong medical terminology and problem-solving skills and good verbal and written communication skills, as well as good computer/Internet skills.
  • Provide product training to new hired agents.  Provide mentoring support till their final assessment.  Facilitated numerous cross function training to new joiners
  • Analysis of member benefits details and policy changes in support of member usability and access and the efficiency of the claim adjudication cycle.

      MIS and RTA :-

  • Responsibility includes publishing various MIS reports for Management like TAT reporting, Error Analysis, Inflow MIS, Daily disbursement Analysis, Process improvement, handling escalations, Quality Improvement thru Error tracking, Team Training and improvements.
  • Processing the data receiving from the Quality, workflow and compiling a consolidated report as required. Preparing daily production reports of team measuring actual performance of each individual with the targeted.

 

Achievements:-

  • Got “Level-1 Processor” Certificate.
  •  Developed operating model system that reduced turnaround time.
  • Rewarded with “TOP GUN” award for the process
  • warded with “Maestro” award for the process.
  • Awarded with “STAR” category award for the process.
  • Awarded for “Excellence in Quality Award” from Client Side.
  • Awarded with “Exceptional Quality” throughout the year .
  • Received the award for “Exceed Client Expectations” from Client Side.

Development Trainings attended at IBM Daksh

·         Interpersonal Skills

·         Business Etiquettes

·         E-Mail Etiquettes

·         Executive Presence                                                                         




(Ashish Rathore)