Krupesh Shah Email & Phone Number

Eden Prairie , Mn, Us

• Leadership of Preventive Action Process: Manages the end-to-end preventive action program, spearheading projects aimed at issue reduction and improved turnaround times.• Root Cause Analysis: Maintains and updates the Root Cause Master Table to drive issue resolution within the business unit.• Cost of Poor-Quality Management: Oversees the implementation and monitoring of Cost of Poor-Quality standards.• Dashboard Development and Reporting: Collaborates with the Enterprise Reporting & Analytics team to create real-time dashboards and metrics for tracking service-level performance.• Command Center Coordination: Partners with Command Centers and resolution teams to develop and maintain the Command Center Playbook, streamlining operations for the sub-segment.• Issue Resolution Leadership: Monitors and manages issue resolution performance, ensuring SLAs are met, and drives continuous improvement in partnership with resolution teams.• Project Management for Preventive Actions: Leads high-impact projects focused on preventing recurring issues and ensuring sustainable solutions.• Stakeholder Relationship Management: Cultivates effective cross-functional relationships to facilitate smooth issue resolution and preventive actions across Optum’s matrix organization.• Readiness Assessments: Supports readiness evaluations for new products and initiatives, ensuring systems are in place for proactive issue management.• Proactive Issue Resolution: Facilitates swift issue resolution, escalates when needed, and ensures clear communication.• Collaborated with Cross-Functional Leaders: Partnered with leaders from various departments to prioritize and implement preventive action strategies, focusing on reducing issues, improving turnaround time, and meeting service-level agreement (SLA) targets.• Oversaw Preventive Action Process: Led initiatives across business units to mitigate risks and improve overall performance.

Frisco, Texas, Us

• Participates in full life cycle development by performing requirements analysis, process development and design, and testing using development methodology.• Collaborates with functional teams, as well as with IT business analysts and programmers to develop detailed design specifications according to standards.• Serves as liaison between departmental team business owners, end users, IT, Claims and Clinical departments.• Supports various departments by providing detailed network matches, provider maps, access and density reporting, reimbursement and underwriting data, ad hoc reports, documenting current and proposed process flows and incorporating analytic methodology and tools.• Creates and maintains standard periodic providers and claim related reports to support operational and network development needs.• Develops and documents workflow, systems requirements, system impact analysis, systems design, process analysis using software development methodology to provide efficient, cost-effective solutions as directed.• Develops and maintains project plans. Manages small to medium sized network related projects, as well as provider and claims system enhancements impacting provider data management.• Conducts new employee and ongoing team member training. Responsible for keeping up with latest software trends.• Managed Projects for New Clients specific reports.• Implemented accuracy and Turnaround Time for existing Internal Network reports.

Woonsocket, Ri, Us

• Secure appropriate documentation to meet financial standards and government regulations• Responsible for supporting multiple market segments all products and/or complex client plan designs.• Conduct research and provide information to internal partners on client benefit set-up. Provide system expertise on benefit set-up and recommend alternative solutions to client or internal partners in meeting client intent. Work directly with client and/or participate in client calls as needed.• Part of the Health Plans Team that assisted in keeping large complex Health Plan Client’s current business and winning new government business.• Managed Projects for New Benefit Clients.• Successfully implemented Medicaid Business

Woonsocket, Ri, Us

• Analyze client documentation to interpret client intent. • Validate testing results to ensure client intent outcome.• Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality.• Created new Quality Check points system for Benefits team for more accuracy.• Responsible of creating more than 1000 macros for coders for faster coding with 100% accuracy.

Woonsocket, Ri, Us

•Responsible for meeting or exceeding turnaround time/client performance guarantees and quality standards.•Perform coding of the clients’ benefit set-up.•Self-monitor work output utilizing quality and testing tools to ensure positive claim adjudication outcomes.• Awarded Quality Excellence awards every quarter for benefit coding accuracy.

Woonsocket, Rhode Island, Us

Responsible for preparing medications & health care products Provided prescribed medical drugs to patients and dealt with compounding of medications, and medical orders. Processed medications via insurance, trouble shoot insurance conflicts & worked with third party companies. Communicated with doctors, nurses and hospital staff for authorizations on specific drugs or insurances. Provided excellent customer service to the patients through friendly communication and maintaining professional relationship

Bachelor Of Science - Bs, Global Business

Associate'S Degree, Global Business Management

Associate'S Degree, Accounting

Information Technology Certification