Raksha .

Experience

• 

  Maharaja Agrasen Hospital

  Sept 2018 - Mar 2019

  Physiotherapy intern
• 

  SAAOL Ortho Care

  May 2019 - Mar 2020

  Consultant Physiotherapist

  - Have assessed and treated various cases like frozen shoulder, upper and lower limb fractures, ligament sprains, low-back ache, arthritis, spondylitis, spondylolisthesis, radiculopathy, post-stroke, traumatic brain injury, and various other musculoskeletal, cardio-respiratory and neurological conditions.- Accomplish treatment plan by administering manual exercises, instructing, encouraging and assisting patients in performing physical activities such as daily living activities, ambulatory functional activities by using therapeutic devices and assistive /supportive devices such as crutches, canes and prostheses. Show less

• 

  Physiomatica

  Apr 2020 - Jun 2021

  Operations Analyst

  - Collaborated closely with the analytics team to analyze clinical data sets to meet the demands of the customer.- Consulted in the healthcare sector and collaboration with the technical team.- Validation, analysis, and evaluation of the deliverable's quality.- Management of end-to-end lifecycle of clinical systems, leveraging strategic thinking, data-driven insights, and strong communication to drive successful product outcomes. - Collaborated with users, delivering cost-effective solutions through streamlined workflows, managed system changes, and conducted rigorous testing.- Performed multiple operational and managerial tasks. Show less

• 

  Optum Global Solutions International B.V.

  Aug 2021 - now

  Working as a Senior Clinical Appeals Reviewer, In the position I am responsible for providing expertise or general support in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances.-Incorporated appropriate parties’ issues, implications, and decisions and Analyses and identifies trends for appeals and grievances with 100 % accuracy in the process.-Investigated more than 3000 claims in 2 years with 100% accuracy.-Expedited problem solving and conducting highly complex analyses achieving 110% throughput for several months.-Encouraged team taking active team engagement activities virtually and physically improving happiness index by 70% for the team.-Maintained quality and accuracy taking various refresher sessions for the team and also attended calibration calls with onshore partners. Show less Worked as a Clinical Investigator involves identifying & processing fraud, waste, and Abuse between medical records and billing services for complex and high-value claims.-Devised Up-coding, Unbundling, Duplication, and Misrepresentation of services and prevented the payment of potentially fraudulent and/or abusive claims saving upto $1000 each claim.-Utilised medical expertise, knowledge of CPT/ diagnosis codes, CMS guideline, and referring to client-specific guidelines member policies.-Handled various claims processing with daily target of 35 cases working in more than 10 specialities.-Achieved various awards such as Star performer and venues performer for several months. Show less

  • Senior Clinical Appeals Reviewer

    Oct 2023 - now

  • Clinical Investigator

    Aug 2021 - Sept 2023