Arundhuti Dasgupta

Review written Adverse Events and/or Product Quality Complaint reports submitted to the drug manufacturer, ensuring timely and accurate transcription into the Quality Management System. Monitor and audit potential sources of safety information, and assist with internal audit support and preparation for third-party audits.

Planned and executed specialized quality assurance audits and operational integrity reviews across the Insurance Services Division. Conducted deep-dive reviews of operational and financial controls, applied risk management frameworks, and led root cause analysis initiatives.

Identified and implemented process improvements to streamline workflows and improve operational efficiency. Provided operational support for tickets and audits, validated requirements through testing, and ran monthly audit reports to ensure data quality.

Led daily operations of a 23-person provider dispute team, achieving quality, productivity, and service goals. Analyzed trends in provider dispute inventory reports, oversaw resolution of disputes, and adjusted policies to meet NCQA and CMS regulatory requirements.

Investigated and resolved provider complaints, grievances, and appeals, responding in writing in accordance with regulatory and departmental standards. Independently investigated and adjudicated appeals, reviewed claims for compliance, and served as subject matter expert.

Delivered differentiated customer service, anticipating needs and proactively resolving issues. Accurately handled cash, check, and credit card transactions while supporting multiple departments with inventory and stocking tasks.

Examined, verified, and processed Medicare, Commercial, and Medicaid claims, including adjustments for inpatient, skilled nursing facility, and general claims. Used electronic claims processing systems and maintained up-to-date knowledge of healthcare regulations.

Audited document repositories for accuracy and compliance with regulatory standards. Prepared and formatted benefit summaries in compliance with government requirements, and verified data integrity using systems such as ICIS and iStream.

Certificate in Medical Insurance Specialist with focus on medical insurance and healthcare claims processing, CPT/ICD-9-10 coding, CMS-1500 claim forms, and HIPAA.