Mahesh Marilingappa

Operations Associate

Bengaluru, Karnataka, India8 yrs 7 mos experience

Key Highlights

Over 7 years of healthcare industry experience.
Expert in claims adjudication and quality assurance.
Proficient in SQL and data analysis for process optimization.

Stackforce AI infers this person is a Healthcare Claims and Quality Assurance Specialist.

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Skills

Core Skills

Claims ManagementBenefit ConfigurationProcess TrainingClaims AdjudicationQuality AssuranceClaims Auditing

Other Skills

10-Key Typing7 QC ToolsAdjudicationAnalytical SkillsAuditingBAUCCSCRMClaim InvestigationClaim adjudicationClaims HandlingClaims ProcessingClaims ResolutionCoachingCommunication

About

Dedicated Healthcare Professional | Claims Adjudication & Quality Assurance Expert With over 7 years of experience in the healthcare industry, I specialize in claims adjudication, processing, auditing, and benefit configuration. My expertise commercial claims, ensuring compliance and accuracy throughout post-adjudication processes. At Carelon Global Solution and Sagility, I excelled in quality assurance, process improvements, and client escalation management. I bring a collaborative approach to enhancing claims adjudication efficiency, quality auditing, and Benefit / pricing configuration. My skills extend to SQL and data analysis, leveraging tools like Power BI to drive insights and improvements. I am committed to achieving organizational excellence through analytical expertise and process optimization.

Experience

8 yrs 7 mos

Total Experience

2 yrs 6 mos

Average Tenure

11 mos

Current Experience

Cognizant

Senior Process Excutive-CONFIGURATION HC

Jul 2025 – Present · 11 mos · Bengaluru, Karnataka, India · Remote

Career break

Professional development

Nov 2024 – Jul 2025 · 8 mos · Bengaluru, Karnataka

I went through DATA SCIENCE COURSE from Intellipaat

Carelon global solutions

Associate Benefits Analyst

Dec 2022 – Nov 2024 · 1 yr 11 mos · Bengaluru, Karnataka, India · Hybrid

Configuring the member benefits in Plan Configuration (PC). After enrolling members into a policy, we will receive a Summary of Benefits (SOB). Based on the SOB, we will configure which services need to be covered, including the amounts and how they should be handled. These are all divided into member benefits known as Copay, Coinsurance, and Deductible. Once the plan configuration is completed, we will conduct an internal audit and will send to test some dummy claims. after received testing response proxy will use for claims payment.

Benefit ConfigurationClaims ProcessingInternal AuditsClaims Management

Sagility

2 roles

Process Trainer

Dec 2020 – Dec 2022 · 2 yrs · Bengaluru, Karnataka, India

As a Process Trainer for US Healthcare, I was responsible for developing and delivering training programs to ensure that team members effectively handled healthcare processes, including claims adjudication, dispute resolution, and compliance with US healthcare regulations. I created tailored training materials, assessed performance, and provided coaching to address skill gaps. By collaborating with operations and quality teams, I contributed to process improvements, enhanced accuracy, and reduced errors. My efforts ensured that teams were well-equipped to meet organizational goals while maintaining high standards of customer service and compliance.

Training DevelopmentComplianceClaims AdjudicationProcess Training

Specialist Quality

Nov 2017 – Dec 2022 · 5 yrs 1 mo · Bengaluru, Karnataka, India

Auditing healthcare claims processed by the operations team. This involves reviewing cases where providers dispute underpayments or overpayments. The operations team adheres to established guidelines, and team members take action based on these standards. We audit their actions to determine whether the decisions made were correct or incorrect. If an error is identified, responsibility is assigned to the associates involved. Our focus is on leveraging ready-to-use skills to deliver exceptional customer service to companies and clients.

Claims AuditingDispute ResolutionCustomer ServiceQuality Assurance