Operations · Data · Risk Adjustment · Automation

Altaf
Simavatwala

Healthcare Risk Adjustment and data operations leader trusted to align clients, teams, and claims execution at scale.

I work at the intersection of client trust, operational rigor, and financial performance. Across 15+ years in US healthcare operations, Medicare Advantage, ACA Risk Adjustment, project delivery, product ownership, analytics, and AI-enabled workflows, I've been trusted to bring structure to high-stakes environments where accuracy, speed, and alignment matter at the same time.

Ahmedabad, India Medicare Advantage ACA Risk Adjustment 15+ Years
20+
Major US insurance carriers handled directly
5000+
End-to-end claims processed monthly
Millions
Patient, provider, and diagnosis records
72→42
Days from visit to payment closure

Data strategy that translates operational noise into clear decisions.

I use reporting logic, prioritization frameworks, dashboards, and forecasting to show what matters, what is waste, and where teams should focus first.

I bring order, accountability, and client confidence to complex healthcare operations.

My strongest work happens in high-friction environments where the stakes are real: revenue, compliance, coding quality, client confidence, and execution discipline all move together. I bring together operational context, data logic, stakeholder alignment, and delivery rigor so that complex systems become clearer, faster, and more dependable.

I operate as a hybrid leader: part client-facing implementation owner, part systems thinker, part delivery operator, and part Risk Adjustment subject matter expert. I'm especially effective in process-heavy healthcare environments where speed alone is not enough and where coding, compliance, denial prevention, and payment accuracy have direct business consequences.

Focus
Healthcare Risk Adjustment leadership, data operations delivery, client-facing implementation ownership, workflow visibility, and ROI-driven operating improvement.
Domain
US healthcare, Medicare Advantage, ACA Risk Adjustment, CMS workflows, HCC coding, concurrent coding, HEDIS, PHA, 837 submissions, billing and revenue cycle.
Strength
Business-to-technology translation, faster implementation, root-cause discovery, KPI design, RADV readiness, denial prevention, billing visibility, workflow redesign.
Scale
20+ major US insurance carriers including UHC, Cambia, BCBS, Humana, and Centene.
Data
Millions of patient, provider, and diagnosis data points plus 5000+ end-to-end claims per month.
Claims
Owned the full claims lifecycle — reduced close-loop cycle time from 72 days to 42 days.
Teams
Led the operating rhythm across 12 coordinated teams.
Location
Ahmedabad, Gujarat, India

Results that prove the pattern.

₹ Crores Shifted client performance from recurring penalties to incentive payouts by focusing teams on milestone-critical outcomes.
$25K Saved in a single month after identifying vendor billing tied to failed automation output.
5000+ End-to-end claims processed monthly across intake, coding, submission, denial handling, and closure.
20+ Major US insurance carrier relationships managed through direct collaboration and disciplined alignment.
12 Teams aligned to keep implementation, coding, claims, reconciliation, finance, and client comms moving as one system.

Three reasons leaders trust Altaf with complex operating environments.

01
He can run complexity across the full healthcare operating chain. From data intake to payment closure, the work stays tied to throughput, revenue, accuracy, and avoided risk so leadership can see control as well as performance.
02
He earns client trust while keeping internal execution aligned. Requirements do not get lost in translation. Altaf turns client goals into clearer workflows, better prioritization, faster implementation, and execution that holds up under pressure.
03
He improves execution without needing formal authority over every team. The pattern across his work is leverage: better visibility, smarter decisions, tighter coordination across 12 teams, and stronger performance without unnecessary overhead.

Built from frontline operations into delivery, product, data, and automation leadership.

The arc matters. I started close to execution, moved through quality and project management, then into product ownership and data account leadership. That means I understand the workflow on the ground, the reporting layer above it, and the strategic expectations sitting on top of both.

2021 – Present Advantmed India LLP
Data Account Manager / Product & Workflow Owner

Led AI-enabled workflow design, analytics visibility, automation tooling, stakeholder-facing delivery, and client-facing data implementations across healthcare data operations. Built the connective layer between client expectations, internal execution, and measurable delivery performance.

2018 – 2021 Advantmed India LLP
Product Owner

Owned backlog prioritization, requirements shaping, workflow implementation, and product delivery for operational tools. Focused development effort on highest-value functionality tied to real client and team needs.

2016 – 2018 Advantmed India LLP
Associate Project Manager

Managed project scope, timelines, cost control, checkpoints, and risk planning across healthcare operations. Built methodologies that reduced delays and made delivery status more legible to leadership.

2009 – 2016 Vodafone / Medusind / Advantmed
Operations, Client Service, and Quality Foundations

Built the operational instincts that still shape my work today: quality control, service delivery, root-cause analysis, training, team calibration, and direct exposure to where process breakdowns actually occur.

Four flagship examples that show how I think, not just what I delivered.

These are the most recruiter-useful stories from my background. Each one demonstrates a repeatable pattern: identify hidden economics, reduce translation loss, redesign the system, and prove the value with real outcomes.

ROI Prioritization

Turned Jira request overload into a business-value roadmap.

I audited six months of requests, grouped them by functional impact and manual effort saved, and interviewed ten departments to find which items were truly worth technical investment.

Result
Backend noise dropped, software effort focused on high-value work, and operations gained a prioritization model grounded in ROI instead of volume.
Revenue Cycle Redesign

Reduced claims-cycle closure time from 72 days to 42 days.

I rebuilt reconciliation visibility using Power BI, removed slow communication layers, and updated commercial terms so late payment behavior had consequences across a multi-million-dollar claims-processing environment.

Close-loop claims-cycle time improved from 72 to 42 days, with faster collections, cleaner accountability, and stronger upstream guidance that reduced preventable rejections.
Operational Leverage

Increased capacity by 20–25% without hiring.

I challenged a long-standing calling-hours assumption, ran a pilot, and proved that a "forbidden" time block performed just as well as standard hours.

One more productive hour per time zone, higher throughput, and meaningful output gains without headcount expansion.
Forecasting + Automation

Built forward-looking visibility and protected teams from costly surprises.

I combined ignored operational reports, historical patterns, anomalies, and external variables into forecasting logic that predicted slippage before it showed up in normal status reporting.

90–95% projection accuracy, better planning, earlier intervention, and higher trust in reporting.

Want the broader story set? Search across the rest of the examples, including QA transformation, portal recovery, implementation design, vendor auditing, and more.

Showing 7 additional case studies.

Implementation Design

Created a source of truth between clients and operations.

I helped build a Data Project Implementation function and introduced a six-page implementation document with both client and internal sign-off before delivery began.

Result: fewer translation failures, cleaner handoffs, and no room for "we didn't know" during execution.
Financial Auditing

Caught automation failure and saved $25,000 in a month.

While reviewing vendor invoices, I found charges tied to failed automation output and later identified a full engine outage that would have triggered widespread eligibility failures.

Result: immediate cost savings, avoided client-facing financial damage, and a larger failure prevented in time.
Quality Assurance

Shifted QA from error policing to process engineering.

I built tracking around recurring error clusters and turned that insight into targeted documents, workshops, and refreshers so teams could fix the source of mistakes.

Result: stronger accuracy, more durable learning, and a culture focused on prevention rather than blame.
Project Recovery

Stabilized a client portal during a mapping crisis.

I audited every Jira ticket and requirement from the start, found broken sub-category mapping and data lag, and introduced stop-gap automation plus a mandatory sync before reports.

Result: client trust was restored immediately while engineering bought time to fix the deeper architecture.
Measurement System

Defined an ROI methodology for every project type.

I standardized how improvements were valued across error reduction, documentation, and process change so leaders could see the real dollars behind performance shifts.

Result: teams could separate vanity wins from value-generating work and redirect effort to the highest-return initiatives.
Incentive Turnaround

Converted three years of penalties into crores in incentives.

I shifted the performance strategy from raw volume to milestone-critical outcomes, isolated bottleneck providers, built a targeted task force, and negotiated directly to accelerate record collection.

Result: the economics of the project flipped from recurring penalties to incentive-tier performance.
Automation Leadership

Bridged departments and developers with a Master Automation Log.

I documented current-state workflows, ranked tasks by criticality and frequency, wrote BRDs, and validated output against real user needs rather than technical assumptions.

Result: automation work consistently delivered measurable hours saved, dollar impact, and stakeholder confidence.

What I bring to the table, beyond job titles.

⚙️

Operations and Delivery

I lead through ambiguity, create structure around cross-functional execution, and keep teams aligned on what matters commercially and operationally.

Project Management Program Delivery RCA Risk Management Workforce Logic
📊

Data and Product Thinking

I use data logic to improve visibility, prioritize correctly, and convert fuzzy requests into decision-ready systems and requirements.

SQL Thinking Power BI Reporting Design Backlog Prioritization BRDs
🏥

Risk Adjustment & Healthcare Domain

I connect AI, automation, and lightweight tooling to real healthcare workflows where accuracy, compliance, coding quality, denial prevention, billing visibility, and throughput all matter at once.

Risk Adjustment Medicare Advantage ACA Workflows HCC Coding Concurrent Coding RADV Readiness 837 Submissions HIPAA

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Available for Remote Opportunities

If your team needs stronger control, faster execution, and better alignment across healthcare operations, that's where I create value.

This site is designed to show how I think, where I create leverage, and the kinds of outcomes I've delivered across healthcare operations, data, Risk Adjustment, claims processing, and client-facing execution.

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