Manisha Shinde

Acted as the primary point of contact between internal departments, vendors, and clients, ensuring timely communication and alignment on project requirements. Utilized Salesforce for case management and project tracking, generating reports and dashboards to provide status updates to business groups. Coordinated implementation and enrollment processes; analyzed and supported EDI transactions includ

Completed SAP Certified Associate – SAP HCM for S/4 HANA certification, demonstrating proficiency in core HR modules including Personnel Administration (PA), Organizational Management (OM), Time Management, and Payroll. Designed and configured a simulated end-to-end HR lifecycle in SAP S/4 HANA, including organizational structure setup, employee master data management, and HR reporting workflows.

• Ensured financial compliance by processing and adjudicating claims with precision and adherence to audit standards.
• Prevented overpayments and fraud by identifying discrepancies and applying corrective actions.
• Collaborated across departments to strengthen reconciliation processes and improve claim accuracy.
• Leveraged multiple systems (WGS, Member 360, ACMP, Blue2, WCF) to streamline claim

Managed diverse caseloads and cleared high-volume tasks under strict Turnaround Time (TAT) requirements. Processed and adjudicated complex healthcare insurance claims, resolving edits in compliance with HIPAA and payer guidelines. Reviewed facility claims (inpatient and outpatient) for health plans and TPAs to ensure accurate and efficient processing; conducted medical records reviews for complete

• Process assigned claims and determine benefits according to client
contract terms.
• Ensure timely payment and adjustment of claims.
• Demonstrate proficiency in claim management, adhering to quality
and compliance standards.
• Resolve various claim edits, including authorization, eligibility, and
medical records discrepancies.
• Utilize WGS, Member 360, ACMP, Blue2, and WCF systems for
eff

• Identifying both monetary and non-monetary benefits for various
initiatives
• Continuously improving intermediary relations and garnering
appreciation.
• Utilizing data analysis techniques including surveys and CHI-Square
method for insights.
• Developing key performance indicators (KPIs) to assess
performance.
• Compiling comprehensive reports for organizational management.

• Supported initiatives to improve employee experience through recognition programs.
• Applied data analysis techniques to gather insights and develop KPIs for measuring impact.
• Designed reports for management to guide decision-making on employee engagement strategies.

GPA: 6.8

GPA: 7.5

Oct 2024