At UnitedHealth Group, I analyzed retrospective healthcare claims to identify aberrant billing patterns and support prospective flags and retrospective recovery. My work included suspicious drug claims, incorrect place-of-service billing, and oxygen equipment claims, with documented savings across those projects.
I partnered with clinical experts, Medical Directors, Policy SMEs, Legal, and Operations to investigate suspected billing schemes and develop FWA controls. I also developed prospective and retrospective rules and edits, and led analytical work on an Ambulatory Surgery Center initiative involving license verification.
Previously, at GENPACT LLC, I analyzed healthcare claims for potential fraud and abuse, including up-coding, unbundling, and masking. Earlier, at Accretive Health India Pvt. Ltd. and IBM Daksh, I supported payment processing, auditing, and Aetna claims work.
