NEHA TABASSUM

Toronto,ON

Summary

Dynamic healthcare professional with a proven track record at Carelon Global Solutions, excelling in benefits analysis and compliance. Skilled in JIRA and healthcare benefits administration, I consistently achieved high-quality outcomes while demonstrating strong analytical and communication skills. Passionate about driving process improvements and delivering exceptional service in fast-paced environments.

Overview

years of professional experience

Certification

Work History

Associate Benefit Analyst /Benefits Analyst

Carelon Global Solutions/Elevance Health

Hyderabad, India

04.2023 - 03.2025

Managed Front Office Benefits System (FOBS) for plan design elements, member packages, and contract codes.
Conducted UAT testing for medical proxy benefit configurations and plan accuracy.
Performed BPD benefit plan design testing across multiple U.S. states to ensure compliance and accuracy.
Designed and implemented new business and renewal healthcare plans, ensuring accuracy in copay, OOP limits, and coverage.
Reviewed updates via SharePoint, OBIS, and JIRA to maintain compliance with client requirements.
Assisted in administration of health, dental, vision, and life insurance benefits with accurate processing.
Utilized JIRA for contract code management, audits, and documentation of EWM tickets.
Applied Addendum processes to integrate clinical codes into plan designs.
Supported major client groups including NYC Transit Authority, Catholic Health Services, and Brookdale Hospital.
Led daily team huddles and prepared/distributed Minutes of Meeting (MoM) to align actions and performance.
Conducted audits of benefit plans to ensure adherence to regulations.
Knowledge of Quality Control (QC) tools for process improvement and accuracy monitoring.
Reviewed plan benefits SME - Review and collaborated with IT to resolve issues and implement accurate benefit plan designs.

Pharma Benefit Analyst /Prior Authorization Pharmacist

Optum Global Solutions India Pvt Ltd

Hyderabad, India

01.2017 - 03.2023

Pharmacy Benefit Management (PBM) process development, evaluation, and documentation.
Reviewed prior authorization requests for medication coverage compliance and accuracy.
Auditing cases, work IDs, and verifying member/provider details, including NPI and drug information.
Skilled in claims, Prior Authorization, home delivery orders, Medicare, Medicaid, Enrollment, appeals and grievances, hospice, and HIPAA.
Proficient in RxClaims macros, eligibility, indexing, order validation, verification, and Citrix queues.
Strong compliance knowledge of the HIPAA Privacy Rule in health plans and claims handling.
Experienced in OJT coaching/training, meeting documentation, and team record management.
Consistently achieved 100% quality, high claim indexing volumes, and process improvement contributions.
Recipient of multiple awards for performance, dedication, and special expertise.

Education

Bachelor of Pharmacy - Pharmacy

Malla Reddy College of Pharmacy

01-2016

Biological Sciences

Sri Chaitanya Junior College

ICSE

St. Martins High School

Skills

Citrix-based NDB and PIMS Applications
Navigator
OBIS – Online Benefit Inquiry System
JIRA – EWM Tickets
Microsoft Office Suite (Word, Excel, PowerPoint)
Macros & RxClaims Automation
Healthcare Benefits Administration
Prior Authorization & Claims Processing
Wide knowledge in healthcare

Strong analytical skills
Strong written
Verbal communication
Effective time management & prioritization
Organizational skills
Excellent presentation skills
Self-motivation
Proactive problem-solving

Accomplishments

Consistently delivered 100% quality in production.
Achieved highest indexing volumes for claims and cases.
Contributed innovative ideas for process improvements.
Recognized with Special Expertise Award for outstanding performance.
Recognized as Best Performer in FOBS with 110% accuracy.