In 2007, I visited India for the first time. At the time, I owned a Medical Billing Company and was interested in exploring the medical billing BPOs (Business Process Outsourcing) business. I was using a BPO in India to help my company scale. It was an era before the rise of social media, a time when anyone could present themselves as a legitimate company through a website, masking their true scale and capability. I was having trouble with my vendor at the time and decided to visit India and check out these businesses firsthand.

To ensure a thorough and safe trip, I invited my friend Mike, a fellow medical billing company owner and a former two-star General in the U.S. Army, to accompany me. Our journey took us on Emirates airline with a layover in Dubai, making the eighteen-hour travel endeavor both demanding and exhausting. Following the adjustment to the time zone and a well-needed period of rest, I found myself primed for my research mission. Armed with a curated list of the top ten medical billing BPO companies in India, Mike and I embarked on a journey of exploration.

Gleaning Insights from the Landscape : Chennai, India is where the Medical Billing BPO’s were first established in 1994. Today, medical billing BPOs have expanded to numerous cities and towns across India, yet Chennai stands as the true hub of medical billing expertise. While some larger entities open satellite offices in rural villages to obtain cost-effective labor, such settings often lack the proficiency that Chennai’s professionals offer.

The “YES” Culture : During our visits, I was greeted with an overwhelming sense of hospitality and importance. Red carpets, bouquets of flowers, personalized welcome signs – the hospitality was beyond anything I have ever experienced. Our appearance as Caucasians naturally caught the attention of locals, resulting in many curious gazes. This eagerness to please often led to an inclination to respond with “yes” to every question and request, even when the feasibility wasn’t guaranteed. Coaching and candid conversations proved necessary to encourage a more realistic exchange. I told them it is okay to be honest and say, “I will need more than one day to complete the project, it will have it done in two days”. It is better to set expectations than to have a disappointed client.

Diversity & Inclusion : Doing business in India is different than doing business in America. One prominent difference lies in the depth of camaraderie between people. While strolling along the bustling streets and through the vibrant malls of India, it becomes evident watching grown heterosexual men walk arm in arm with their friends. This symbolizes a genuine care for one another, emblematic of the robust friendships and bonds that flourish here. This unique societal fabric contributes to the cultivation of an exceptional work culture. A remarkable feature of the Indian business landscape is the harmonious collaboration between individuals of diverse backgrounds. Hindus, Muslims, and Christians collaborate seamlessly, working side by side and mutually honoring each other’s holidays and traditions. This interfaith harmony extends beyond mere coexistence – it fosters genuine friendships among individuals irrespective of their religious beliefs.

The Head Nod : The American way of demonstrating no is moving your head from side to side. In Indian culture moving your head from side to side means yes, I am listening. This can be very confusing for an American on their first trip, as it was for me. I quickly learned the head nod code and had productive conversations going forward.

Serious Photo Faces : I noticed from the many photos I took that there were a lot of serious faces. Different cultures have varying norms regarding facial expressions, including smiling. In some cultures, a more reserved or neutral expression is considered appropriate for formal photos, while in others, smiling is seen as a sign of friendliness and approachability. In some parts of India, maintaining a composed demeanor in photos may be more customary. Serious faces in pictures don’t mean unhappy people, just a more formal way of presenting themselves.

Indian Management Dynamics :

India’s caste system still exerts its influence, with a noticeable emphasis on job titles. While Americans often prioritize earning potential, Indians place high importance on job titles or designations. My observations revealed a trend – higher title levels often correlated with a decreased workload.

Many of the companies I visited employed numerous “freshers,” employees with limited medical billing experience, following rudimentary training. These employees were often paid below minimum wage, while clients were charged full price, resulting in a profitable business model. However, I believe in the critical role played by experienced medical billing professionals across various aspects of the process. Training, hiring the right people, and having a dynamic company culture is critical for hiring and retaining top talent. The attrition in the Indian BPO market is extremely high, a company that does not have an excellent culture will quickly lose its employees creating instability for their clients.

Command and Control Leadership :

After visiting the top 10 BPO’s in Chennai, one thing was clear to me, the employees seemed nervous and afraid. You can sense it when walking into these offices. My perception was that there was no focus on culture. The employees were hired to do a job and they better do it – or else….

A Pivotal Decision: Founding 4D Global

After that trip in 2007 I decided to start 4D Global – an American owned and managed medical billing company in India. I was going to employ some of the best and most experienced talent in all of India. A commitment to genuinely caring about our people, fostering a culture of inclusivity and shared voice within the company. Our vision encompassed a workplace filled with joy and a place of belonging – a space that celebrates birthdays, weddings, births, and holidays. The vision for 4D Global was clear – to be a workplace sought after by Indians, nurturing an environment where the best talents flourish and progress within the organization. A workplace filled with opportunities for growth and advancement, a commitment we have proudly upheld and expanded upon.

Deepesh Rana

Executive Vice President & Head of Operations

Deepesh is an accomplished executive with 22+ years of experience in operations management. He has a proven track record of driving operational efficiency, optimizing processes, and delivering results. As an Executive Vice President and Head of Operations, Deepesh is responsible for overseeing a range of functions critical to our company’s success, including HR, finance, IT, and facilities management. He oversees all aspects of our company’s operations, logistics & administration.

Deepesh is a strong advocate for customer service and employee engagement and is committed to creating a positive workplace culture that fosters collaboration and innovation. He is dedicated to delivering exceptional results and is passionate about helping 4D achieve its full potential. Prior to joining 4D, he held senior operations roles where he successfully implemented operational improvements that increased efficiency and reduced costs.

Hobby & Interest: Deepesh is an avid traveler and loves exploring new destinations across the world. He has a young family & prefers spending quality time with his daughter, wife, and mother.

Randy Farwell

Senior Vice President of Business Development and Marketing

Randy has 25 years of experience in the Healthcare Industry as a team builder, team leader, and national sales manager. He is passionate, dynamic, creative, and innovative. He has a successful career in the Healthcare Industry by maximizing business performance through a foundation of strategy, analytics, as well as people and culture development. Demonstrated success driving multi-million-dollar sales growth, developing, and building company infrastructures, building sales and business development teams, and executing sales strategies. He is known for strategy development and execution and has broad cross-functional experience in sales management and sales operations.

Randy will be leading our sales, business development, and marketing teams. He will be developing, implementing, and executing our sales, marketing, and growth strategies. He is dedicated to building leaders and helping others to achieve success. He will be creating new business opportunities and strategic partnerships for 4D Global Inc.

Hobbies and Interests: Randy enjoys exercising, lifting weights, golfing, pickleball, and spending time with family and friends.

Chanie Gluck

Founder & CEO

Chanie Gluck is a successful entrepreneur and seasoned veteran of the medical billing business. She launched 4D Global, Inc. after selling her Medical Billing Company – 4D Medical, which she owned and operated for 13 years. Chanie began her medical billing career in 1994 working in the billing department of a multi-specialty medical center.

Chanie is a visionary entrepreneur with 28+ years of experience in the medical billing industry. She has a passion for making healthcare effective and efficient through outsourcing capabilities. Under Chanie’s leadership, 4D Global has grown from a startup to a fast-growing company Inc 5000 company and a leader in the medical billing market. As the Founder and CEO of 4D Global, Chanie is responsible for setting the strategic direction of the organization and driving growth and success.

She is deeply committed to 4D’s mission and values and is dedicated to delivering exceptional results for our customers and stakeholders. She hosts two podcasts’ Leaders In Medical Billing and Growing Global .  Chanie’s entrepreneurial journey includes being recognized as one of the top CEO’s & She is also actively involved in corporate social responsibility initiatives and is committed to making a positive impact on the world.

Check out her website at

Hobby & Interest:  Yoga, cycle classes, art – painting, reading, lifetime learner, world traveler and enjoys spending time with her husband and four children.