At Optum, I analyze out-of-network claims reimbursement with SQL and Power BI, creating exception reports that surface payment variances and support arbitration case preparation.
I built dashboards to track claim volume, reimbursement rates, and denial trends. My analysis identified a recurring gap in a prior-authorization and contract-pricing workflow, prompting operations to revise its intake and arbitration review process.
Previously, I delivered claims reimbursement and denial analytics for healthcare payer clients at Accenture and Wipro. I also built an out-of-network reimbursement dashboard and a claims denial root cause analysis workbook using SQL, Power BI, Excel, and Python.
