Cosmas B. Ashibeshi

Spearheaded data accuracy initiatives by collecting and validating critical data from diverse sources (claims, member demographics, healthcare providers), significantly reducing reporting errors and ensuring data consistency across internal systems and regulatory submissions.

Led an Excel-based data analysis project to identify key trends and patterns within large datasets, leveraging statistical techniques and data mining to extract actionable insights that inform strategic decision-making and optimize hospital admission rates.

Developed and deployed interactive dashboards using Excel and Power BI, providing critical visualizations of enrollment trends, treatment types, and provider performance, which significantly enhanced data-driven decision-making for executive and operational teams.

Conducted in-depth analysis of claim rejections, approval delays, and processing inefficiencies, leading to targeted recommendations that reduced average claim turnaround time by 25% through process optimization.

Identified and reported anomalies and patterns indicative of potential fraudulent activities, including billing fraud, identity theft, and inappropriate healthcare utilization, safeguarding organizational assets.

Systematically collected and consolidated healthcare data from diverse sources, including claims databases, Electronic Health Records (EHRs), and external providers, ensuring data integrity for downstream analysis.

Managed the accurate entry and tracking of healthcare claims from hospitals and enrollees, ensuring precise coding and documentation to facilitate efficient processing and timely payments.

Maintained strict compliance with data protection regulations (e.g., NHIA, GDPR, NDPA) for all confidential health and personal data, mitigating compliance risks.

Provided essential operational support by generating daily, weekly, and monthly reports on key metrics such as enrollment trends, claims processing status, pending investigations, and approvals, enabling informed operational adjustments.

Collaborated cross-functionally with IT, claims assessors, and customer service teams to effectively troubleshoot and resolve complex data-related issues and discrepancies.