Jun 2023 – Present · 2 yrs 9 mos · Remote 🌍 · Remote

• Excited to embark on the digital transformation journey as a Lead Business Consultant at Maantic Global, a cutting-edge firm at the forefront of innovation.
• Key Responsibilities and Achievements:
• Strategic Planning: Spearheading the formulation and execution of comprehensive digital transformation strategies, aligning business objectives with technological advancements. 🌐🎯
• Consultative Leadership: Collaborating closely with stakeholders, executive leadership, and cross-functional teams to assess business needs, identify opportunities, and deliver tailored solutions that propel Maantic Global into the digital age. 🤝💡
• Innovation Integration: Guiding the integration of innovative technologies, methodologies, and best practices to enhance operational efficiency, foster innovation, and ensure a competitive edge in the market. 🛠️🚀
• Change Management: Implementing effective change management processes to seamlessly transition the organization, its processes, and its workforce into a digitally optimized and agile environment. 🔄📈
• Client Engagement: Cultivating and nurturing client relationships by understanding their unique challenges, providing consultative insights, and delivering value-driven solutions that contribute to both client and organizational success. 🌐🤖
• Team Leadership: Mentoring and leading a dynamic team of professionals to collectively achieve digital transformation goals. 🤝🏆
• In my role as Lead Business Consultant at Maantic Global, I am privileged to contribute to the company's evolution in the digital landscape. Our collaborative efforts are shaping the future of the organization, positioning it as an industry leader in the era of digital innovation.
• Excited to be part of Maantic Global's transformative journey, I am dedicated to driving impactful change, fostering innovation, and ensuring sustained success in the dynamic digital landscape.

Apr 2021 – Jun 2023 · 2 yrs 2 mos

• Principal Business Analyst | Solution-driven | Client-focused | Requirement Expert
• 🔍 Bridging the Gap: As a Principal Business Analyst, I specialize in providing tailored solutions to address complex client challenges. I excel in understanding client requirements and ensuring their seamless implementation, acting as a key liaison between the product owner and the development team.
• 🤝 Collaborative Approach: By fostering strong relationships with stakeholders, I am able to gather, elicit, and elaborate on requirements, ensuring a thorough understanding of project goals and objectives. This collaborative approach allows me to deliver optimized solutions that align with the client's vision.
• 💡 Continuous Value Delivery: I am committed to enabling the continuous delivery of value throughout the product development lifecycle. By leveraging my expertise in business analysis, I help drive the development of solutions that meet client needs and contribute to the success of the overall project.
• 🎯 Client-centric Focus: With a deep understanding of client pain points and objectives, I work diligently to identify the most effective strategies and requirements for successful project outcomes. My aim is to provide exceptional value and exceed client expectations at every stage.

Jun 2016 – Apr 2021 · 4 yrs 10 mos

• Agile Business Analyst | Proxy Product Owner | Pega Tool Expert | Cross-Functional Collaborator
• 🎯 Precision in Requirements: As an Agile Business Analyst, I excel in the critical tasks of requirements gathering, elicitation, and acting as a proxy product owner for owned Epics. I ensure clarity by coordinating with clients and stakeholders, delivering precise and well-defined requirements.
• 🤝 Seamless Collaboration: I actively participate in epic and story grooming, product backlog refinement, and coordination with both product owners and internal teammates. By fostering strong partnerships, I contribute to the creation of well-defined user stories and a refined product backlog.
• 🚀 Efficient Delivery: With a keen understanding of Pega tools, I optimize business rules configuration, streamlining the work of developers. I am proficient in using debugging tools like clipboard and tracer to ensure smooth application performance.
• 💡 Agile Framework Expertise: I conduct Dynamic Case Management (DCO) sessions, ensuring requirements and specifications are accurately updated in the Pega tool. I utilize Agile Studio and Pega Agile Workbench to track sprint and release activities, enabling efficient collaboration and transparency.
• 📊 Accurate Sizing and Estimation: I contribute to the sizing of user stories using techniques such as planning poker, providing high-level estimates (T-shirt sizing) during plan reviews and detailed Epic estimates during Backlog Change Requests (BCR).
• 🔧 Cross-Functional Contribution: Being part of an Agile team, I embrace a cross-functional approach, taking ownership of activities such as bug validations, bug fixing, unit testing, regression testing, sanity testing, and system testing, particularly during releases.
• 🌟 Scrum Team Player: Within the Scrum team, I actively engage in sprint planning, product backlog grooming, sprint backlog creation, and user story development.

Mar 2021 – Present · 5 yrs · Remote · Remote

• As a GLG Network Member, I bring 15 years’ of experience in the healthcare, Health Insurance, Health Tech and Business process modelling industries to help clients solve some of their toughest business challenges around digital transformation, digital process automation and healthcare delivery and end-to-end revenue cycle management services.
• GLG is the world’s insight network. It connects decision makers to the right experts so they can act with the confidence that comes from true clarity and have what it takes to get ahead. Its network of experts is the world’s largest and most varied source of first-hand expertise.

Mar 2021 – Apr 2023 · 2 yrs 1 mo · Remote · Remote

• As a Healthcare and specifically health claims consultant, I contributed to this company in sharing my healthcare as well as health claims knowledge in building some top notch and innovative products using exciting AI capabilities.

Aug 2020 – Mar 2022 · 1 yr 7 mos · Hyderabad, Telangana, India

• Data Analyst Fellow | Unlocking Data Insights | Visual Storyteller | Driving Better Outcomes
• 🔍 Unleashing Data Potential: As a Data Analyst Fellow at AlphaAI, I am dedicated to unlocking the potential within datasets. I meticulously identify relevant data sources, curate and cleanse the data, and organize it to reveal meaningful insights and trends.
• 📊 Transforming Data into Actionable Insights: With expertise in data analysis, I excel in creating interactive and visually captivating dashboards. By harnessing the power of data visualization, I enable stakeholders to uncover outliers, discover actionable items, and make informed decisions that lead to better outcomes.
• 💡 Adept at Data Exploration: I thrive in the realm of data exploration, employing advanced techniques to uncover patterns, correlations, and trends that may have otherwise remained hidden. By diving deep into the data, I uncover valuable insights that drive impactful strategies and solutions.
• 🚀 Driving Data-Driven Decision Making: By presenting data-driven insights in a compelling manner, I empower organizations to make informed decisions that positively impact their bottom line. My work facilitates a culture of data-driven decision making, fostering continuous improvement and growth.
• 🌐 Collaboration and Impact: Working collaboratively with teams, stakeholders, and subject matter experts, I ensure the alignment of data analysis with organizational goals. By effectively communicating data findings and recommendations, I influence positive change and drive measurable outcomes.

Sep 2017 – Aug 2023 · 5 yrs 11 mos · Hyderabad, Telangana, India · On-site

Jan 2016 – Mar 2022 · 6 yrs 2 mos

• Senior Homeopathic Consultant | Healing Lives | Expertise in Classical Homeopathy
• 💼 Sagar Homoeo Stores: As a Senior Consultant at Sagar Homoeo Stores, one of Hyderabad's leading Homoeopathic chain clinics, I have dedicated my career to treating, counseling, and healing patients, helping them lead happier and healthier lives. With over 10+ years of rich clinical practice, I have gained extensive experience in Homeopathic case taking and practicing classical Homeopathy.
• 🌟 Success Stories and Expertise: Throughout my practice, I have achieved numerous success stories, adding to my credit as a Homeopathic consultant. My areas of expertise lie in the treatment of allergies, lifestyle disorders, and more. I take pride in creating hope among those who may have been skeptical about Homeopathic treatments and have effectively managed conditions that would have otherwise required surgeries, using the power of Homeopathic medicines.
• 💻 Tele-Consultation Availability: I am also available for tele-consultations on Lybrate, providing convenient access to individuals seeking my expertise in Homeopathy. Whether you have health concerns or require guidance, please feel free to reach out to me via the specified link.
• Let's Connect: If you are seeking a Senior Homeopathic Consultant with a proven track record of healing lives and a deep commitment to classical Homeopathy, let's connect. Together, we can embark on a journey towards better health and well-being.
• ✉️ drpraveen.ganapathiraju@gmail.com | 🌐 [http://www.lybrate.com/drgvspraveen]
• Reach out to me to discuss how Homeopathy can contribute to your overall health and wellness. Let's work together to achieve holistic healing!

Sep 2012 – Dec 2015 · 3 yrs 3 mos

• Physician and Homeopathic Consultant | Healing Lives | Expertise in Classical Homeopathy
• 🏥 Sagar Homoeo Stores: As a Homeopathic Consultant at Sagar Homoeo Stores, one of Hyderabad's leading Homoeopathic chain clinics, I have had the privilege of serving as a physician, providing holistic healthcare solutions to patients. Here, I have gained extensive experience in treating patients and honed my skills in Homeopathic case taking and practicing classical Homeopathy.
• 🌟 A Track Record of Success: Throughout my practice, I have achieved remarkable success stories, adding to my credit as a Homeopathic physician. My expertise lies in the treatment of various conditions, including allergic rhinitis, migraine, urticaria, psoriasis, disc disorders, mental ailments, sinusitis, dermatitis, arthralgia, rheumatoid arthritis, and osteoarthritis, among others.
• 💡 Embracing Holistic Healing: As a dedicated physician, I believe in the power of holistic healing. By understanding each patient's unique needs, I provide personalized treatment plans that address their physical, emotional, and mental well-being. My approach to Homeopathy is rooted in the principles of classical Homeopathy, ensuring comprehensive and effective care.
• Let's Connect: If you are seeking a knowledgeable and compassionate Homeopathic Physician with a proven track record of healing lives and expertise in classical Homeopathy, let's connect. Together, we can explore how Homeopathy can contribute to your overall health and well-being.
• ✉️ drpraveen.ganapathiraju@gmail.com | 🏥 Sagar Homoeo Stores | Hyderabad

Jan 2015 – Jun 2016 · 1 yr 5 mos

• Medical Reviewer | Ensuring Accurate Claims Assessment | Expertise in Healthcare Adjudication
• 🔬 Ensuring Medical Necessity: As a Medical Reviewer, my primary focus is on meticulously reviewing health claims to determine the medical necessity of services rendered. I play a crucial role in assessing whether the services billed align with established medical guidelines and protocols. By providing support to claims adjusters across different teams, I ensure accurate claims assessment and benefits review.
• 💼 Underwriting Excellence: I excel in conducting underwriting reviews for high-dollar claims, leaving no detail unchecked. With meticulous attention to detail, I ensure that every claim is thoroughly examined and that payments are made correctly. My expertise in this area ensures optimal risk management and financial accuracy.
• 💡 Core Competency Areas: My core competencies lie in a range of critical areas within medical review and adjudication, including international medi-claim processing, appeals handling, denial management, provider relations, medi-claim audits, report handling, team correspondence, client relationship management, grievance handling, and medical analysis to assess the loss ratio of different enrolled groups. Additionally, I contribute to business analysis based on client requirements and support the development of insurance adjudication software.
• 🌐 Collaboration and Support: I provide valuable onshore team support by addressing medical and process-related queries, fostering a culture of knowledge sharing and continuous improvement. By leveraging my expertise and experience, I contribute to enhanced customer satisfaction and operational efficiency.
• Let's Connect: If you are seeking a skilled Medical Reviewer with a strong background in healthcare adjudication, claims assessment, and underwriting, let's connect. Together, we can ensure accurate claims processing and optimal utilization of healthcare resources.

Dec 2013 – Dec 2014 · 1 yr

• International Claims Adjuster | Expert in Health Claims Adjudication and Processing
• 💼 Analyzing, Reviewing, and Processing: As an International Claims Adjuster, I have played a pivotal role in the analysis, review, and processing of international health claims. Throughout my tenure, I have gained extensive experience in all aspects of health claims adjudication, starting from claim intake, review, processing, payments, and reporting. I have supported junior claims examiners by reviewing claims based on medical necessity and repudiating those that do not meet the required criteria.
• 💡 Core Areas of Expertise: My expertise lies in international health claims adjudication, where I have demonstrated proficiency in processing member claims, provider claims, HCFA, UB claims, and various other claim types. I possess sound knowledge of the US healthcare system, ensuring compliance with regulations and industry standards. Additionally, I have in-depth understanding of medical coding, including ICD-9, CPT, and HCPCS codes. I bring valuable skills in medical research and review, claim and medical audits, as well as handling queries, appeals, and correspondence.
• 🌐 End-to-End Claims Processing: With comprehensive knowledge of the claims process, I excel in managing claims from initial ID generation to payment release. This end-to-end understanding enables me to ensure accurate and timely processing, delivering optimal customer service and satisfaction.
• 🔎 Commitment to Quality: I am dedicated to maintaining the highest standards of quality and accuracy in claims adjudication. By leveraging my expertise and attention to detail, I contribute to efficient claims operations, minimizing errors and maximizing efficiency.

Jul 2012 – Dec 2013 · 1 yr 5 mos · Hyderabad Area, India

• Medical Officer for Claims Adjudication | Leading High-Performing Teams, Expertise in Middle East Claims
• 👩‍⚕️ Leading Claims Adjudication: As a Medical Officer for Claims Adjudication at Infinite Med tech solutions, I have successfully led a team of claim adjusters, providing them with valuable inputs regarding the medical necessity of claims, claims review, benefits review, accurate payment calculations, and ensuring payments are processed within the agreed Turnaround Time (TAT).
• 🌍 Expertise in Middle East Claims: I specialize in Middle East claims management, working extensively on E-claims, member claims, provider claims, cashless and reimbursement claims. Additionally, I have hands-on experience in claim reconciliations, claims audit, and proactive coordination with stakeholders to address any grievances, as well as handling under or over payments.
• 💡 Core Areas of Expertise: My core competencies include health claim validation and processing, specifically focused on Middle East claims. I possess strong auditing skills, ensuring compliance with industry standards and regulations. I have expertise in scrutinizing claims from Kuwait, Dubai, and Abu Dhabi, along with proficiency in settlement of resubmission claims. I excel in E-claims handling from Dubai and Abu Dhabi, prompt escalation handling, and query resolution within stipulated timeframes. Moreover, I am adept at denial management with valid justifications, preparing and updating Table of Benefits (TOB), auditing claims scrutinized by the medical team, managing provider relations, and handling escalations and grievances.
• 🏆 Driving Operational Excellence: With my leadership and subject matter expertise, I have successfully optimized claims adjudication processes, streamlining workflows and ensuring accuracy and efficiency. I am committed to delivering exceptional results by focusing on quality, continuous improvement, and customer satisfaction.

May 2010 – Jul 2012 · 2 yrs 2 mos

• Quality Analyst | Pre-Policy Medical Checkups | Underwriting Support | Fraud Investigation
• 🔍 Validating Medical Reports: As a Quality Analyst at UHG, my primary focus was on conducting thorough pre-policy medical checkups and meticulously validating medical reports and clinical outcomes for all claimants of health and life insurance policies. I ensured accurate assessments to determine policy issuance and insurability based on the individual's health status.
• 📋 Underwriting Support: I provided underwriting support to various life insurance companies, leveraging pre-policy checkups, medical conditions, and lab reports to assess risk and make informed decisions on policy underwriting. By carefully analyzing health conditions and evaluating associated risks, I contributed to effective policy management.
• 🏥 Pre-Employment Check-ups: I successfully managed pre-employment checkups for esteemed organizations, overseeing the health status of individuals being recruited. I ensured comprehensive health evaluations, recommended necessary lifestyle changes, and promoted a healthy and productive workforce.
• 💼 Core Areas of Expertise: My expertise lies in delivering exceptional underwriting support to life insurance companies. I specialize in underwriting policies based on pre-policy checkups, medical conditions, and lab reports. I excel in handling medical assessments prior to policy enrollment, conducting medical underwriting assessments based on the insured's health condition, and facilitating pre-employment check-ups. I maintain a steadfast commitment to maintaining 100% quality in reporting pre-policy medical checkups and assessing the insurability of the insured individuals. Additionally, I possess skills in fraud investigation.
• 🌟 Driving Quality and Risk Management: Throughout my career, I have prioritized delivering meticulous and accurate assessments to support risk management and uphold the highest standards of quality.

Jul 2009 – May 2010 · 10 mos · Hyderabad Area, India

• Medical Officer | Claims Adjudication | Pre-Authorization | Client Relationship Management
• 🏥 Claims Adjudication: As a Medical Officer for Claims Adjudication at Heritage Health TPA Pvt Ltd, I played a pivotal role in evaluating and adjudicating claims based on medical necessity, conducting comprehensive claims reviews, assessing benefits, and ensuring accurate and timely payments with appropriate deductions. I consistently adhered to agreed-upon Turnaround Time (TAT) to expedite claims processing.
• 💼 Cashless Claims Head: During my tenure, I served as the Cashless Claims Head, responsible for efficiently managing pre-authorizations within a stipulated turnaround time of 2-3 hours. By providing swift and seamless pre-authorizations, I ensured that insured individuals could access the necessary care without any delays. I effectively coordinated with hospitals, insured individuals, and other stakeholders to facilitate timely authorizations and minimize any inconveniences.
• 🤝 Client Relationship Management: I have extensive experience in client relationship management and documentation, serving as a reliable point of contact for clients throughout the claims process. I attended client meetings and insurer meetings, actively sharing insights and providing valuable inputs on loss mitigation, timely claims settlement, and grievance handling. By fostering strong relationships, I enhanced client satisfaction and ensured smooth collaboration.
• 📑 Core Competency Areas: My expertise spans across claims processing, pre-authorization, client relationship management, and documentation. I have successfully managed claims for various product portfolios, including conducting on-site visits, performing thorough physical inspections, scrutinizing supporting documents, and maintaining meticulous records. I have experience in adjudicating insurance policies from both private and public sectors, and I excel in provider relations, investigation, and audit activities.

Dec 2007 – Nov 2008 · 11 mos · Hyderabad Area, India

• House Physician | Medicine, Surgery, Gynecology & Obstetrics, Community Social Preventive Medicine
• 🏥 Medicine Department: As a House Physician, I worked in the Medicine Department, where I encountered a diverse range of medical cases such as Chronic Bronchitis, Alcoholic Cirrhosis of Liver, Muscular Dystrophy, Eczematous eruptions of the Skin, Rheumatic Arthritis, and Chronic Follicular Pharyngitis. Through hands-on experience, I developed the skills to effectively manage and treat these cases, gaining valuable insights into their diagnosis, treatment, and long-term care.
• ⚕️ Surgery Posting: During my Surgery posting, I had the opportunity to observe and participate in various surgical cases, including Varicosity of veins, Benign Prostatic Hypertrophy, Acute Appendicitis, Intestinal Obstruction, Traumatic prolapsed Intervertebral Disk, and Inguinal Hernia. This exposure enabled me to differentiate between surgical and medical cases and develop proficiency in managing surgical conditions with appropriate interventions.
• 🤰 Gynecology & Obstetrics: In my Gynecology and Obstetrics posting, I provided assistance to senior doctors in the treatment of diverse cases, including normal deliveries with typical occipital presentation, as well as rare presentations like breech and shoulder. Additionally, I gained experience in Caesarian sections and forceps deliveries. This exposure allowed me to witness various developmental anomalies during pregnancy and broadened my understanding of reproductive healthcare.
• 🌍 Community Social Preventive Medicine: During my posting in Community Social Preventive Medicine, I actively participated in medical camps conducted in rural Indian villages and slums. I played a vital role in disease diagnosis, management, treatment, and prognosis, working closely with the local communities. I distributed medicines to those in need and actively contributed to medical campaigns focused on educating rural population.