Sushma D
@sushmad
I lead US healthcare operations, governance, quality, and global delivery transformations.
IndiaWhat I'm looking for
I've led US healthcare operations and delivery governance across Evolent Health International, Cognizant, DST Worldwide, Mphasis, and Solutioneyes Consultancy Services. My work spans claims adjudication, benefit configuration, enrollment, billing, payment posting, client transitions, and stabilization across India and the US.
At Evolent Health International, I led onboarding for two global clients, established scalable operational frameworks, and aligned Delivery, Engineering, QA, Product, and Business teams on enterprise initiatives. I built executive dashboards with JIRA Analytics and Power BI that reduced issue-resolution time by 25%, and helped reduce defect density from 29% to 9% through preventive quality controls and standardized governance.
I've managed teams of 60+ associates, built staffing and resource models, strengthened SLA and KPI governance, and developed future-ready teams through recruitment, onboarding, training, and mentorship. I bring deep US healthcare payer expertise and use Agile, Lean Six Sigma, RCA, and data-driven process improvement to improve quality, reduce rework, and deliver reliable outcomes.
Experience
Work history, roles, and key accomplishments
Manager - Configuration
Evolent Health International
Jun 2021 - Jul 2026 (5 years 1 month)
Led end-to-end implementation and onboarding of two global clients, directing cross-functional operations across India and the US. Built executive-level dashboards using JIRA Analytics and Power BI, reducing issue resolution time by 25% and defect density by 69%.
Managed and mentored a team of 60+ associates, driving performance and operational excellence. Managed end-to-end payment reconciliation across commercial, Medicare, Medicaid, and managed care payers, ensuring timely payment posting.
Manager BPO Operations – Claims Adjudication
DST Worldwide
Feb 2016 - Apr 2019 (3 years 2 months)
Coordinated transition and stabilization of Medicare Claims Adjudication processes, developing staffing models and project plans. Managed end-to-end payment posting processes including ERA/EFT workflows and 835 transactions.
Assistant Operations Manager- Benefit Configuration & Benefit Narratives
Mphasis
Mar 2008 - Oct 2015 (7 years 7 months)
Managed end-to-end operations for the Healthcare Business Unit with accountability for service delivery and SLA adherence. Worked with a large US healthcare payer in designing health insurance products including HMO, PPO, POS, and ASO plans.
Assistant Operations Manager- Benefit Configuration
Mphasis
Mar 2008 - Oct 2015 (7 years 7 months)
Managed end-to-end operations for the Healthcare Business Unit with accountability for service delivery and SLA adherence. Worked with a large US healthcare payer in designing health insurance products including HMO, PPO, POS, and ASO plans.
Claims Analyst
Solutioneyes Consultancy Services
Sep 2004 - Nov 2007 (3 years 2 months)
Processed and adjudicated HCFA, UB, Dental, and Pharmacy/Drug claims in accordance with healthcare policies. Validated member eligibility, provider information, and benefit levels, and processed payments or denials accordingly.
Education
Degrees, certifications, and relevant coursework
University of Pune
Bachelor of Science, Microbiology
Bachelor of Science in Microbiology from the University of Pune, completed in 2003.
Tech stack
Software and tools used professionally
Availability
Location
IndiaAuthorized to work in
Job categories
Skills
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