SS
SUSHANT SHRIPATI GOSAVI
Contact details — on requestProof of Work — on request
Experience
Senior Advisor 2
Concentrix Pune · Apr 2024 – Present
C
Senior Representative – Medicare Appeal & Grievance
Concentrix Daksh Services India Pvt. Ltd., Pune · Apr 2024 – May 2025
- Medicare Part D Appeals and Grievance: Review and scrutinize appeals and process appeals into the computer system as per the provided LPs/guidelines
- Determine authorization for denial, identify and elevate appeal and grievance accurately within a TAT.
- To Maintain the client error data.
- Maintained HIPAA compliance and followed insurance payer guidelines.
- Conducted quality checks and audits to maintain data accuracy.
Senior Process Executive
Infosys BPM · Dec 2021 – Apr 2024
I
Quality Auditor – Provider & Member Appeals
Infosys BPM Limited, Pune · Jun 2023 – Apr 2024
- To perform Compliance Audit on the cases those are performed by another team and to provide feedback in case of any discrepancies.
- Maintain daily tracker in Excel Sheet also creating templates and dashboards as per the requirements.
- Generate weekly/monthly report and share to it with Quality Team and Manager.
- To attend weekly conference call with onsite team to discuss on escalated issues or any new updates and share the related updates with the team.
- Conducted training sessions.
I
Senior Process Executive - Provider & Member Appeals
Infosys BPM Limited, Pune · Dec 2021 – Jun 2023
- Complaint and Appeal Processing: Review and scrutinize appeals and process appeals into the computer system as per the provided LPs/guidelines
- Determine accurate claims payment or denial, identify and elevate dubious claims or system issues to process the appeal accurately.
- Correct errors or omissions on claim and investigate questionable data.
- To maintain Quality as per the SLA.
- To maintain Productivity as per the SLA.
- To follow all regulatory requirements and procedures as per the company policy display high levels of professionalism in the work delivered and overall conduct.
Skills 0 proven through work
Also works with
CPT Coding KnowledgeHealthcare Document PreparationMedical Necessity ReviewApplication MonitoringStakeholder Communication AdaptationCompliance ManagementTechnical Training DeliveryProblem SolvingTechnical TroubleshootingTechnical Knowledge SharingUnique ID ManagementMedication Handling & PrescriptionsCustomer Issue ResolutionCustomer Eligibility AssessmentKYC ProcessingPatient Rights, Consent & PrivacyService Quality AssuranceInternal Audit ExecutionSOP AdherenceWorkflow CoordinationPrior Authorization SubmissionVendor CoordinationCustomer Relationship BuildingDocument VerificationInsurance Verification
Proof of Work
Proof of Work
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Education
Master's Degree, Economics
Shivaji University, Kolhapur · 2017 — 2019
Bachelor of Arts (B.A.), Arts
Not Provided · 2014 — 2017
Contact details
Contact details
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