Ayush Singh
West Delhi
Summary
I am a skilled Senior Claims Representative with 4+ years of experience in U.S. healthcare insurance, working with companies like Concentrix(Aetna)/(CIGNA), Aflac, and Genworth. Specializes in claims processing, audits, policy renewals, and client coordination, with proficiency in tools like PEGA, TruCare, and MS Office. Known for problem-solving, adaptability, and professionalism, I have earned awards for performance and excellence. Well-versed in HIPAA, medical billing, Insurance compliance.
I am a passionate and enthusiastic person that takes pride in whatever task I undertake, my aim is to deliver high-quality results at the end of every task. In addition, I have good Management skills which enable me to communicate with people on all levels to provide the best outcome for both parties as a whole. This has given me the confidence to carry out any given task with passion and enthusiasm. It also taught me the importance of communicating effectively both verbally and written as this helps build rapport and trust.
Overview
5
5
years of professional experience
Work History
Senior Claims Representative
Genworth Financial India Private Limited
Remote
07.2024 - Current
- Utilize critical thinking and problem-solving skills to drive accurate claim decisions and transaction processing.
- Proactively manage customer relationships through effective communication with claimants, caregivers, and facilities.
- Prioritize and manage multiple responsibilities in a fast-paced team environment with tight deadlines.
- Adhere to structured procedures and SOPs to ensure consistent claims resolution, making informed decisions when faced with complex scenarios.
- Foster collaboration across teams to achieve common objectives, emphasizing solutions over problems.
- Uphold a culture of professionalism, accountability, respect, and teamwork (P.A.R.T.) to foster engagement.
- Flexible availability to meet diverse customer needs and maintain service excellence.
Senior Executive
Coforge
Gurgaon
11.2022 - 01.2024
- Working for one of the U.S Healthcare (Aflac - American Family Life Assurance Company) that provides Cancer/Specified Disease, Dental, Hospital Confinement Indemnity & Intensive Care, Life, Specified Health Event, Short Term Disability, Vision and Accidental insurance related products and services.
- Co-ordinate with the onshore partner to get the update while working on any cases.
- Meeting the client target and SLA.
- Creating the claim after finding from the documents which has been submitted by the provider & insured member.
- Maintaining cases in PEGA tool & CPS.
- Processing of the Cancer, Hospital, Accidental, & Vision claim by checking the iView image.
- Resolve the escalated cases from onshore team.
- Checking Authorization.
Senior Transaction Specialist
Concentrix Daksh Services India Pvt Ltd.
Gurgaon
03.2021 - 08.2022
- Working for one of the top U.S Healthcare Giant (CIGNA) that provides corporate medical, dental, disability, life and accidental insurance related products and services.
- Make profound use of Implementation Tools to conduct different types of tasks per client’s need.
- New corporate account set up/ New Business.
- Renew the existing accounts as per client’s demand.
- Complete the PROCLAIM inventory file provided by the client.
- Co-ordinate with the onshore partners to get updates while working on any group task.
- Resolve the escalated task.
- Do the internal Audits and share the feedback with the up line manager.
- Provide support to the NHT (New Hired Trainees) as an adhoc support.
- Checking Authorization.
Advisor
Concentrix Daksh Services India Pvt Ltd.
Kolkata
07.2020 - 12.2020
- Working for one of the top U.S Healthcare (Aetna) that provides corporate medical, dental, disability, life and accidental insurance related products and services.
- Make profound use of Implementation Tools to conduct different types of tasks per client’s need.
- New corporate account set up/ New Business.
- Renew the existing accounts as per client’s demand.
- Co-ordinate with the onshore partners to get updates while working on any group task.
- Resolve the escalated tasks
Education
Bachelor Of Commerce - Accounting
University Of Calcutta
Kolkata04.2020
Skills
- Claims
- Inpatient
- Outpatient
- Invoice
- CPS
- PEGA
- Calypso
- Claims Management
- Claims Investigation
- Vipr
- iView
- Xnet,
- TruCare
- EviCore
- Claim Processing
- Claim Review
- Claim Management
- WFT - Work Force Management
- MS Office/Teams
- Compliance
- HIPPA(Health Insurance Portability and Accountability Act)
- Home Care
- Long Term Care
- Acute Care
- Hospice
- Behavioral Claims
- Cancer Claims
- Medical Coding
- Medical Research
- Medical Claims
- Medical Billing
- VLOOKUP
- Insurance verification
- Adjudication
- Critical Thinking
- Decision Making
- Communication
- Problem Solving
- Leadership
- Adaptability
LANGUAGES
English
Hindi
Hobbies and Interests
Listening To Songs
Accomplishments
- Client Recognized Most Effective Associate Award - 2021
- Rising Star In The Job Role - 2021
Timeline
Senior Claims Representative
Genworth Financial India Private Limited
07.2024 - Current
Senior Executive
Coforge
11.2022 - 01.2024
Senior Transaction Specialist
Concentrix Daksh Services India Pvt Ltd.
03.2021 - 08.2022
Advisor
Concentrix Daksh Services India Pvt Ltd.
07.2020 - 12.2020
Bachelor Of Commerce - Accounting
University Of Calcutta