Dynamic Program Specialist with proven expertise at Neovance, excelling in claims processing and customer service. Adept in insurance guidelines and data entry, I leverage strong problem-solving and leadership skills to enhance client satisfaction and streamline operations. Committed to delivering high-quality results and ensuring compliance with regulatory standards.
Work History
Program Specialist
Neovance (Allegis Services India Private Limited)
Bangalore
11.2025 - Current
Completed day-to-day duties accurately and efficiently.
Prioritized and organized tasks to efficiently accomplish service goals.
Assisted with customer requests and answered questions to improve satisfaction.
Contact insurance companies via phone to verify patient eligibility, benefits, and authorization requirements for services/medications.
Accurately enter and update patient demographics, insurance details, and coverage information in Siebel databases.
Ensure adherence to payer guidelines and regulatory policies.
Coordinate with providers to ensure appropriate CPT codes support services.
Documentation- Precisely document calls, coverage details, and tracking numbers.
Obtain necessary pre-authorizations and referrals for planned treatments.
Inform patients of their financial responsibility (copays,deductibles, coinsurance and out of pocket network) and explain coverage.
Spec Claims Examiner
Great West Global Business Servics India Private llp
09.2022 - 01.2024
Reviewed Dental, Medical records and documents to determine coverage eligibility of claims for insurance benefits.
Initiated contact with providers to obtain additional information needed for accurate adjudication of claims.
Double-checked and reviewed documentation for denied and accepted insurance claims.
Reviewed and resolved open claims and change orders to determine entitlement for additional payment.
Investigated discrepancies in claims and resolved issues with provider via telephone or written correspondence.
Conducted daily reviews on claim files and verified sending of status letters to policyholders.
Reviewed medical treatment records, medical bills.
Interacted with clients via telephone, email, or in person to discuss claim status and provide updates.
Processed claims for payment or forwarded to appropriate personnel for further investigation.
Empower- Canada Life
Claims Associate
Carelon Global Solutions India llp
08.2019 - 08.2022
Interacted with clients via telephone, email, or in person to discuss claim status and provide updates.
Increases client satisfactory by giving 100% quality work resulting in increased work flow to organization.
Reviewed medical records and documents submitted by claimants to ensure accuracy and completeness of information provided.
Processed payments for approved claims in a timely manner, adhering to established payment schedules and procedures.
Performed quality control checks on completed claim files prior to submission for review by management personnel.
Verified details with policyholders and requested additional information.
Processed claims for payment or forwarded to appropriate personnel for further investigation.
Assisted claimants, providers and clients with problems or questions regarding claims.
Handled billing related activities focused on medical specialties.
Legato Health Technologies llp - Anthem Inc
Education
Bachelor of Commerce - Accounting and Taxation
Kristu Jayanti College Autonomous
Bangalore
05-2019
Pre-University Course - Commerce
St. Charles Women's PU College
Bangalore
03-2016
High School - Bangalore
St.Charles English High School
Bangalore
04-2014
Skills
Ms Excel
Ms PowerPoint
Ms Word
Basic python
SAP Application
Leadership Skills
Time Management Skills
Problem Solving
Data entry
Insurance guidelines
Medical records review
Customer service
Personal Information
Date of Birth: 05/23/98
Nationality: Indian
Marital Status: Married
Projects
Central Host Project and Solutions, Worked on a timely manner and completed the given schedule within 1 year with high accuracy.
Achievements Awards
Impact Award for the Best Performance (3 Consecutive Times)
Trained on Solution Central for new joiners.
Trained on Mappo Claims IA, HHC, SA for new joiners.
Mentoring the New Joiners.
Activities
NSS Certificate
Basic Python Certificate
Timeline
Program Specialist
Neovance (Allegis Services India Private Limited)
11.2025 - Current
Spec Claims Examiner
Great West Global Business Servics India Private llp
Executive Assistant Business Partner– Senior Specialist at Intuit India – Product Development Centre Pvt. Ltd.Executive Assistant Business Partner– Senior Specialist at Intuit India – Product Development Centre Pvt. Ltd.