Santosh Adimulam

Nationality: Indian

 (+91) 9959580029
Date of birth: 15/08/1990
Gender: Male

 Email address: pallisanthu@gmail.com

 Address: 17-219, New venkateshwara Nagar, North Lalaguda Secunderabad, 500017 Hyderabad (India)

MANAGEMENT AND LEADERSHIP SKILLS

Roles and Responsibilities

◦ Handling a large team of 40 plus associates.
◦ Training the new users/associates while onboarding.
◦ Filling the gaps in the process.
◦ Drive accountability with team leads and their teams to meet quality performance goals and ensure
program standards are met on a week over week basis
◦ Assess and prioritize the top-quality issues affecting the teams on your site across all decision-making
channels
◦ Provide details to local teams around the impact of the policy change on the team's current work and
surfaces gaps in knowledge, process, and technology between the intent of the Content Policy and how
content review takes place
◦ Actively re-review decision accuracy audits to ensure consistency and alignment with our internal policies
◦ Facilitated the execution of worldwide C- Ops QA strategy through local management, operations teams,
and support teams
◦ Responsible for documentation of quality metrics, communicating root causes to operations, and carrying
forward lessons learned from quality concerns
◦ Verified Quality Metrics in place and met goals, triggered containment actions and corrective actions as
appropriate
◦ Managed, coached, and developed a high performing Quality team that meets agreed objectives, and
which delivers best practice results, added value, and continuous improvements
◦ Communicated across all levels on Operations and program progress. 
◦ Provided focused feedback loops for teams based on performance and quality data.
◦ Conducted Root Cause Analysis (5 Whys Analysis/ Fish Bone Analysis) and Error Trend Analysis
◦ Drove defect elimination program by working along with Ops and Program stakeholders.
◦ Drove efficiency improvements by eliminating nonvalue add processes and introducing automation
capabilities- Analyzed the key levers of the business to identify trends and proactively take action to
improve efficiency and quality.
◦ Worked with software teams to articulate and prioritize feature needs for systems and tools.

WORK EXPERIENCE

Quality Control Analyst

Legato Health Technologies [ 14/09/2020 – Current ]
City: Hyderabad
Country: India

◦ Handled a large team of 40+.

◦ Identify and obtain additional information needed to make an appropriate determination
◦ Leverage appropriate resources to obtain all information relevant to the claim
Associate
WIPRO LIMITED [ 04/11/2019 – 13/09/2020 ]
City: Hyderabad
Country: India

◦ Claims failed at the auto adjudication level require processing, which involves interpretation of claim
forms, timely submitted filing proofs, eligibility related forms, receipt of payments given for a particular
service, employer’s records, and provider’s or customer’s reports and statements along with other
supportive documents attached to perform the necessary action.

Senior Analyst
R1 RCM Global Private Ltd [ 24/09/2018 – 03/10/2019 ]
City: Hyderabad
Country: India

◦ Complete knowledge of US Health Care, concepts like Patient responsibilities (Co-Payment, Deductible,
and Co-Insurance & Premium), Explanation of Benefits (EOB), Out of pocket (OOP), Timely Filing Limit,
Payment methods, Coordination of Benefits & Carve-Outs.
◦ Researching and analyzing the Health claims HCFA 1500 & UB04 forms.
◦ Adjusting the EOB & COB billing information in the claims

Claims Associate
Optum Global Solutions [ 27/07/2015 – 14/09/2018 ]
City: Hyderabad
Country: India

◦ Determine whether an additional appeal or grievance reviews are required (e.g., medical necessity) and
whether additional appeal rights are applicable
◦ Determine where specific appeals or grievances should be reviewed/handled, and route them to other
departments as appropriate
◦ Identify and obtain additional information needed to make an appropriate determination

DIGITAL SKILLS

Core Competencies
FMEA / Quality Management / SOP validations and recommendation / Transition Management / Rigorous and
Prag / Operations monitoring / Quality Management System / Stake holder management / Continuous Quality
Improvements / Change management / Quality Green Belt Projects / Corrective actions / User Acceptance
Testing / Team building / Multitasking abilities / Process Excellence / Internal and external auditing & reporting / L
eadership training / Analytical skills / Training solutions development / Process evaluation and enhancement / Pro
cess validation / Defective analysis

Digital Skills
COMET / UNet / Availity / Blue Square / 7 QC tools / Reflection space
EDUCATION AND TRAINING

B.Com (Computers)
Kakatiya Degree College [ 07/05/2010 – 06/07/2013 ]
Address: Hyderabad,

Intermediate
Gowtham Junior College [ 09/06/2008 – 07/04/2010 ]

SSC
Shanthinikethan High School [ 05/06/2004 – 02/03/2008 ]

LANGUAGE SKILLS

Mother tongue(s): Telugu

Other language(s):
English
LISTENING C1 READING C1 WRITING C1
SPOKEN PRODUCTION C1 SPOKEN INTERACTION C1