1. #47/5 E, Sai Krupa Bungalow,
Chandan Nagar, Pune-411014
Email: bravo.mukesh@gmail.com
Mb-91+8805086700/9561554412
MUKESH KUMAR
OBJECTIVES:
Seeking a challenging position in an organization of repute where my existing skills and
competence can be utilized while being resourceful, innovative and flexible.
SYNOPSIS:
 Detail-oriented and dedicated professional with more than 8.3 years of proven expertise in
end-to-end configuration, business analysis, and production support in the healthcare
payor.
 Proficiency in end-to-end implementations including benefits, providers, contracts and
Utilization management
 Extensive knowledge of health care products, such as HMO, Indemnity, PPO, POS, EPO,
Medicare, and Medicaid.
 Excellent written, communication, inter personal, liaison, team handling and problem
solving skills with the ability to work in multi cultural environment.
EXPERIENCE (Present to past)
1. Company Profile:
TriZetto, A Cognizant Company is Powering Integrated Healthcare Management. With technology
solutions touching more than half the U.S. population today, TriZetto, A Cognizant Company is
uniquely positioned to drive the convergence of core benefit administration, care management and
constituent engagement. TriZetto, A Cognizant Company provides premier information technology
solutions that enable payers and other constituents in the healthcare supply chain to improve the
coordination of benefits and care for healthcare consumers. TriZetto, A Cognizant Company mainly
deals with claimAdjudication and plan configuration in Facets and QNXT.
Company Name : TriZetto, A Cognizant Company.
Designation : Team Leader (Business Rule Configuration)
Department/Process: Configuration Services/Business Rules Configuration (BRC)

2. Duration : 24th Jan ’11 to till date
Skills used : Knowledge of US Healthcare & Insurance
ROLES AND RESPONSIBILITY
 Designing and developing various health insurance products for US client as per the
specifications given by US Federal laws.
 Research and analysis on new requirement and providing recommendation to client on the
basis of new updates in CMS or Federal law etc
 Benefit code-set identification and documentation.
 Benefit configuration for ASO, Medicare Advantage, PPO, EPO and POS lines of business.
 Configuration of various kind of contract such as professional, Hospital, Home health, Skill
nursing, Ambulance, Anesthesia, Freestanding lab/path etc.
 Configuration of fee table such as Custom, DRG, RBRVS, UCR etc.
 Troubleshoot and correct claimprocessing edits and errors.
 Gathering and documenting business requirements.
 Production support for pended claims issues related to benefit errors including in-depth
research and resolution.
 Developed test scripts and conducted testing of various processing systems and modules.
 Creation and maintenance of SQL tables related to configuration requirement.
 Communicated out the project status to all levels of management on a weekly basis,
including executive leadership.
 Facilitated the definition and identification of project resources.
 Organized project status deep dives, risk assessment, issue logging, escalation and
resolution processes
 Created and maintained the master project plans of all project deliverables including issues
and risks.
 Provided expert guidance to the overall Master Project Plan that serves as the road map for
all lines of businesses and vendors to follow.
EXPERIENCE
1. Company Profile:
HGS is a world leader in customer relationship management and business process outsourcing.
It provide contact centre services, back office processing and IT solutions to a global clientele

3. comprising several Fortune 500 Companies. HGS has a global footprint with 51 delivery centers
in Canada, France, Germany, Italy, India, Jamaica, Mauritius, the Netherlands, the Philippines
, the United Kingdom and the United States of America.
Company Name : Hinduja Global Solution (HGSL)
Designation : Senior ClaimProcessor
Department/Process : Sr. Claims processor
Duration : 4th July ’07 to 20th Jan ‘11
Skills used : Knowledge of US Healthcare & Insurance
ACHIEVEMENTS
 Many times rewarded based on my performance
 Rewarded by management for act as a good team player
 Received client appreciation based on my analytical skill
CERTIFICATION
 Facets Level 1,2,3,
 QNXT Level 1,2,3
QUALIFICATION (Present to past)
 BCA
From IGNOU, Ranchi (Jharkhand)
Year of passing: 2004
Percentage of marks: 58.25%
 H.S.S.C
From Ganesh Lal Agrawal (GLA) College, Daltonganj (Jharkhand )
Year of passing: 1998
Percentage of marks: 54.88%
 S.S.C
From Giriwar High School, Daltonganj (Jharkhand )
Year of passing: 1996
Percentage of marks: 55.85%
IT SKILL SET

4.  Platform : window XP/98/2000
 Microsoft Office
 SQL
 MS Access
STRENGTHS:
 Responsible
 Time Management
 Optimistic
 Strong communication, interpersonal and negotiation skills
 Quick learner and Adaptable
 Motivated and dedicated to getting the job done right.
 Courteous and professional
 Flexible to work in any shift
PERSONAL INFORMATION:
Father’s Name: Shri Shyam Bihari Prasad.
Date of Birth: 24th Dec 1981.
Nationality: Indian.
Sex: Male
Marital Status: Single
Passport: Yes
Permanent Address: AT-Redma ranchi road
P.O.- Daltonganj
Dist- Palamau
State- Jharkhand
Pin code-822101
Language Known: Hindi and English.
Place: PUNE (India)
Date: _ _ / _ _/ _ _ _
MUKESH KUMAR