Hari Palani

Results-driven Manager with 16+ years of experience in the US healthcare industry, possessing a strong knowledge of healthcare processes and operations. Proven track record of successfully managing projects, ensuring quality and productivity, and providing excellent customer service. Skilled in process management, data reconciliation, client relationship management, and quality management. Adept at communicating effectively with customers and stakeholders, and experienced in creating and maintaining detailed project plans, risk mitigation documentation, and business requirement documents.

Seeking opportunities as a Healthcare Manager to implement innovative ideas into solutions that can transform business issues into profitable growth enablers for organizational growth and success.

• Clients: Exela Technologies - USA, Exela – Data Aggregation, Provider – St. Joseph, Anthem & UHG Appeals Management E-Submissions, TPA - Rio Tinto, UK Healthcare - Claims Management System, Payer – McKesson, PCH Global Copay Assistance Program - Secondary Claim Adjudication Platform Development, Payer - UMR & BSC, EON Provider and Member suspense Automation, Payer – Meritain, EDI Clearing House support Process, Payer – BSCA & PacifiCare UHC, EON - Edit Resolution Claims Delivery
• Spring Benefit Administration – Health and Welfare Benefit Administration Management
• Carrier Connection - Carrier Connection is a technology solution that enables providers to submit claims, correspondence, appeals, and medical records to payers electronically, streamlining the submission process and improving efficiency
• Rio Tinto (TPA Process) - UK Healthcare Claims Adjudication/Management System
• Meritain - EDI Clearing House support Process
• McKesson - PCH Global Copay Assistance Program [Adjudication Platform]
• UMR & BSC - EON Provider and Member Suspense Automation
• BSCA - EON Edit Resolution Claims Delivery Automation
• Claims Adjudication and Pre-Adjudication and Mailroom services – United Healthcare PacifiCare and Blue shield of California

• Manager, Portfolio Management Healthcare, 2022 - Present
• Assistant Manager, Portfolio Management Healthcare, 2016 - 2022
• Production Coordinator, Portfolio Management Healthcare, 2015 - 2016
• Project Coordinator, Portfolio Management Healthcare, 2013 - 2014
• Junior Executive / Team lead Operations, 2010 - 2011
• Senior Associate in QA, Operations, 2008 - 2009

• Delivering Claims (Pre-Adjudication & Adjudication) for Blue Shield of California and United HealthCare
• Handling 25+ team members
• First level communication with customer and responsible for all email communication
• Responsible for project PLM
• To initiative the new reps training – Adjudication process training
• Playing SME role and troubleshooting
• To involve in new reps training certification
• Tracking and Monitoring VEPS activities (Value Engineered Performance System)
• Effectively involved in Problem Solving, Strategic Planning, Forecasting the Cost controls
• Strong Knowledge in US HealthCare Industry
• Responsible for day-to-day productivity per customer requirements
• Responsible for quality as per SLA
• Need to maintain the consistence performance per SLA – Preparing the action if any SLA fails
• Responsible for claims TAT per SLA
• Responsible for Knowledge transfer from customer end to our end processors
• Responsible to present the project performance to internal management on a weekly basis
• Need to present the project performance to Customer on a monthly basis

• Awarded by HOV Service Management as Standout Performer for exceeding expectations as well for retention bonus
• Stabilized a new project from the view point of Production and Quality and gained 100 % result from the client
• Participated in customer training and successfully completed project transaction
• Successfully implemented various improvement tools like (Inventory Management Tool, Web Reports –Productivity)
• Automation of Member & Provider Edits Resolution (Through Komodo FCB Business Rule Engine)
• Involved in new initiatives with respect to project automation
• Managed projects from initiation to delivery, ensuring quality and productivity
• Developed and implemented processes to improve customer satisfaction and reduce defects
• Conducted root cause analysis to identify areas for improvement and implemented corrective actions
• Mentored team members to improve their skills and performance
• Achieved 5 out of 5 in client satisfaction survey feedback
• Received Extra Mile stone award from Exela for consistency in Deliverables

• Title: Manager, Healthcare
• Date of Birth: 07/11/1988
• Gender: Male
• Nationality: Indian
• Marital Status: Married