Aldera
Anjali Singh
Claim Adjudicator I
Agra,UTTAR PRADESH
Summary
Focused Claims Adjudicator enthusiastically pursuing a claim Adjudicator opportunity to leverage 2 years of client relationship building and claims management expertise. Highly skilled in research, data verification and claims adjustment with a passion for fostering corporate mission. Specialties: -
I have good knowledge of U. S. health care insurance terms. I am working in U. S. healthcare process for last 2+ years, Good knowledge about all US health care terminologies like :- Deductible, coinsurance, Copay, Out of pocket maximums, (COB) coordination of Benefits, (EOB) Explanation of Benefits, HCFA 1500, UB92/UB04, CMS.
Worked on various Queues like eligibility, psdp, sql, pcp for different clients.
Also worked in appeal intake process for provider appeals.
Proficient in handling CMS and UB claims.
Overview
4
4
years of professional experience
6
6
years of post-secondary education
1
1
Certification
1
1
Language
Work History
Claims Adjudicator
Evolent Health
Pune, Maharashtra
04.2021 - Current
- Working knowledge of claims adjudication, Full claim load (FCL) on Aldera software
- Claims adjudication for Medical, UB claims on Aldera software.
- Always maintained 100% accuracy level. Executed claims processing, while generating increased revenue.
- Provided training to new resources in project. Prepared reports and handled reporting work.
- Worked on Appeal intake process for provider appeals . Worked on pilot project for new client.
- Collaborated with team members and management to meet goals.
- Investigated high volume of insurance claims to determine validity and coverage eligibility.
- Verified insurance claims and determined fair amount for settlement.
- Handled complaints and grievances using negotiating and problem-solving skills.
- Researched claims and incident information to deliver solutions and resolve problems.
Claims Adjudicator
SATech
Pune , Maharashtra
07.2020 - 03.2021
- Worked for client Evolent Health Pune(on contract basis) as claims adjudicator.
- Verified insurance claims and determined fair amount for settlement.
- Investigated and processed insurance claims for policyholders.
- Correctly verify procedure codes to properly classify claims.
- Worked on various queues like Eligibility, Possible duplicate, PCP , Sql for 3 different clients .
Education
12th - PCB
Agra Public School
Agra 04.2014 - 05.2015
B.Tech - Biotechnology
Amity University Rajasthan
Jaipur 08.2016 - 07.2020
10th -
St.Conrad’sintercollege
Agra 05.2012 - 05.2013
Skills
Claims processing paperwork
Certification
Marketing Management
Additional Information
Good with various programming languages like C, C++, Java , sql , Object oriented programming language.
Completed minor degree in marketing during college.
Complete language course for German.
Software
Timeline
Claims Adjudicator
Evolent Health
04.2021 - Current
Marketing Management
08-2020
Claims Adjudicator
SATech
07.2020 - 03.2021
B.Tech - Biotechnology
Amity University Rajasthan
08.2016 - 07.2020
12th - PCB
Agra Public School
04.2014 - 05.2015
10th -
St.Conrad’sintercollege
05.2012 - 05.2013
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