Abhishek A S
Thiruvananthapuram
Summary
Results-driven Healthcare Insurance Professional with 4+ years of expertise in Insurance Claim Processing and Insurance Accounts Receivable (AR) Analysis. Experienced in reviewing insurance claim statuses, interpreting EOBs, validating insurance coverage and authorization requirements, and ensuring strict compliance with insurance payer guidelines to facilitate accurate claim processing. Adept at insurance denial resolution, claim root-cause analysis, and AR follow-up to minimize turnaround times. Possesses strong analytical and problem-solving skills with a proven ability to improve insurance claim outcomes, maintain quality standards, and drive operational efficiency.
Overview
4
4
years of professional experience
Work History
Senior Associate
Guidehouse India Pvt Ltd
04.2022 - 07.2026
- End-to-End Claim Adjudication & Processing: Audited and processed complex medical claims for U.S. healthcare payers, ensuring compliance with coverage terms and regulatory guidelines.
- Complex Denial & Discrepancy Analysis: Performed root-cause analysis on rejected, underpaid, and denied claims-interpreting EOBs/RAs to execute corrective re-adjudication and resubmissions.
- Policy Compliance & Quality Assurance: Evaluated claims against HIPAA regulations and payer-specific policy guidelines to maintain high audit quality and eliminate compliance risks.
- Coverage & Eligibility Verification: Validated patient coverage, benefit structures, and pre-authorization requirements to ensure upfront claim accuracy and prevent processing exceptions.
- Cross-Functional Issue Resolution: Partnered with coding, medical billing, and clinical teams to clarify documentation gaps, resolve complex claim discrepancies, and streamline workflow efficiency.
- Inventory & High-Value Claim Management: Analyzed pending and aging claim inventories, prioritizing high-value and time-sensitive cases to enhance claim resolution speed.
Education
B.Tech - Electrical Engineering
Vidya Academy of Science & Technology
01-2021
Higher secondary Education -
GHSS Bharathannoor
01-2017
High school -
Lourdes Mount HSS, Vattappara
01-2015
Skills
- Denial Management
- Insurance Eligibility Verification
- AR Follow-up & Aging Analysis
- Claims Resubmission & Resolution
- CPT/ICD Knowledge
- EOB analysis
- HIPAA Compliance
- Microsoft Excel
- Documentation
- Benefits verification
- Policy interpretation
- Claim processing
Timeline
Senior Associate
Guidehouse India Pvt Ltd
04.2022 - 07.2026
B.Tech - Electrical Engineering
Vidya Academy of Science & Technology
Higher secondary Education -
GHSS Bharathannoor
High school -
Lourdes Mount HSS, Vattappara