# Radhika Shiva

Radhika Shiva is a remote worker on Himalayas, Senior Out of Network Operations Analyst at Optum, based in United States.

Source: https://himalayas.app/@radhikashiva

```text
Senior Out of Network Operations Analyst at Optum, using SQL and Power BI to surface reimbursement variances and improve claims workflows.
```

| Detail | Value |
| --- | --- |
| Availability | Looking for a job |
| Location | United States |
| Authorized to work in | United States |
| Salary expectations | 90k+ USD |
| Job categories | Out of Network Operations Analyst, Business Analyst |
| Skills | Out Of Network, Revenue Cycle Operations, Reimbursement Analysis, ADR Workflows, Denials Management, Payer Contracts, Claims Adjudication, Root Cause Analysis, Reconciliations, Data Validation, Variance Analysis, KPI Dashboards, Trend Analysis, Data Modeling, Query Optimization |

## About

```text
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.
```

## Experience

### Senior Out of Network Operations Analyst (current)

[Optum](https://himalayas.app/companies/optum). Aug 2025 - Present

```text
Owned out-of-network claims reimbursement analysis using SQL and Power BI, building exception reports and dashboards to track claim volume, reimbursement rates, and denial trends. Standardized reporting across payer segments, reducing manual effort by 25%.
```

Skills: SQL, Power-BI, DAX, Power-Query, Excel, KPI-Dashboards, Trend-Analysis, Root-Cause-Analysis, Data-Validation, Variance-Analysis, BRD, Stakeholder-Management, Jira, Confluence, Agile

### Business Analyst

[Accenture](https://himalayas.app/companies/accenture). Sep 2022 - Dec 2023

```text
Delivered claims reimbursement and denial analytics for a healthcare payer client using SQL and Tableau, and documented BRD/FSD artifacts for workflow enhancements. Coordinated UAT and consolidated payer data sources into unified reporting views.
```

Skills: SQL, Tableau, Excel, Requirements-Gathering, BRD, FSD, UAT, Process-Mapping, Stakeholder-Management, Jira, Confluence, Agile, Data-Reconciliation, Variance-Analysis

### Business Analyst

[Wipro](https://himalayas.app/companies/wipro-limited). Mar 2020 - Aug 2022

```text
Developed recurring claims and reimbursement reports for a healthcare payer client using SQL and Tableau, and validated data extracts to reconcile source records with reporting outputs. Improved data accuracy by 20% through systematic validation checks and root cause analysis.
```

Skills: SQL, Tableau, Excel, Data-Validation, Root-Cause-Analysis, Exception-Based-Reporting, Process-Mapping, Requirements-Documentation, Stakeholder-Management

## Education

### University of Alabama at Birmingham

Master's, Computer Science. Grade: 3.5 / 4.0

```text
Pursuing a Master's in Computer Science with a GPA of 3.5 out of 4.0.
```

## Tech stack

- Snowflake
- Tableau
- NumPy
- Pandas
- Jira
- Python
- Confluence
- Git
- SQL
- Power BI
- Power Query

To contact Radhika, message them from this profile with a Himalayas employer account: [Hire on Himalayas](https://himalayas.app/hire).

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