Open to opportunities

Sowmiya Kanakarathinam

@sowmiyakanakarathina

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Experienced healthcare claims leader skilled in FACETS, SQL, and process optimization.

India

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What I'm looking for

I seek roles leveraging claims adjudication, process improvement, and automation in a collaborative healthcare environment that values data-driven decisions and professional growth.

I am a healthcare claims professional with deep experience in FACETS, ABS mainframe, SQL, and MS Excel who has supported US Medicaid and Medicare projects for Centene and BCBSIL. I have led teams of 20+ staff, improved claims workflows, created automation (MACROS) and reporting solutions, and presented actionable data insights to leadership to influence strategic decisions.

My background includes adjudicating UB-04 and HCFA-1500 claims, managing appeals and grievances, conducting root-cause analysis, and collaborating with QA, configuration, HR, and clients to resolve defects and reduce processing time. I hold an Academy of Healthcare Management (AHM 250) certification and consistently earned awards for performance and subject-matter expertise.

Experience

Work history, roles, and key accomplishments

Team Leader

Cognizant Technology Solutions

Dec 2019 - Feb 2022 (2 years 2 months)

Led a team of 20+ in high-volume claims processing for BCBS Illinois and Centene, created MACRO-enabled tools and daily production reports that increased automation and reduced delivery costs, and managed client communication and escalation for aging and high-dollar claims.

Claims Processing Facets ABS (Mainframe)SQL Team Leadership Client Communication Automation

Senior Healthcare Analyst

Cognizant Technology Solutions

Dec 2017 - Nov 2019 (1 year 11 months)

Acted as SME for Centene and BCBS IL claims—analyzed and trended claim issues, performed root cause analysis, authored business requirements, and streamlined FACETS workflows to reduce processing time by 18%.

And Claims Analysis Facets Root Cause Analysis SQL Clinical Data Analysis Reporting

Claim Adjudication Analyst

Cognizant Technology Solutions

May 2014 - Dec 2017 (3 years 7 months)

Processed and finalized HCFA-1500 and UB-04 claims with strong coding accuracy (CPT, ICD-10, HCPCS), met productivity and SLA targets, and resolved high volumes of repetitive claims while maintaining quality.