Divya Tiwari
Mumbai
Summary
Detail-oriented Medical Claims Executive with hands-on experience in cashless and reimbursement claims processing, documentation verification, and coordination with hospitals and TPAs. Strong understanding of IRDA guidelines, policy interpretation, and TAT management. Known for accuracy, compliance, and effective claim query resolution.
Overview
8082
8082
years of post-secondary education
Work History
Executive Operations
Finhaat Insurance Broking Pvt. Ltd.
Mumbai
12.2022 - 06.2023
- Processed and reviewed medical insurance claims in line with policy terms, IRDA norms, and company SOPs.
- Verified critical claim documents including hospital bills, discharge summaries, prescriptions, and investigation reports.
- Coordinated with hospitals, TPAs, and internal teams for claim approvals, clarifications, and settlements.
- Handled cashless and reimbursement claims, including pre-authorization and post-authorization checks.
- Maintained high data accuracy and ensured timely processing to meet defined TAT targets.
- Identified discrepancies and resolved claim-related queries, helping reduce claim rejections.
- Ensured strict confidentiality of patient and policyholder information.
- Assisted in audits and ensured adherence to regulatory and internal compliance standards.
Education
B.Sc -
Indira Gandhi Open University
PanvelMBBS (Discontinued) -
Uzhhorod National University
UkraineHSC -
NES Ratnam Jr College
Bhandup, WSSC -
Guru Nanak English High School
Bhandup, WSkills
- Medical Insurance Claims Processing
- Cashless & Reimbursement Claims
- Pre-Authorization/ Post-Authorization
- Documentation Review & Scrutiny
- Hospital & TPA Coordination
- Policy Interpretation (IRDA Guidelines)
- TAT & Workflow Management
- Claim Query Resolution
- Data Accuracy & Compliance
Languages
Hindi
First Language
English
Advanced
C1
Marathi
Intermediate
B1
Timeline
Executive Operations
Finhaat Insurance Broking Pvt. Ltd.
12.2022 - 06.2023
B.Sc -
Indira Gandhi Open University
MBBS (Discontinued) -
Uzhhorod National University
HSC -
NES Ratnam Jr College
SSC -
Guru Nanak English High School
Additional Details
Immediate joiner / Flexible availability, Comfortable with high-volume claim processing environments
Disclaimer
I hereby declare that the information provided above is true and correct to the best of my knowledge.
Additional Details
Immediate joiner / Flexible availability, Comfortable with high-volume claim processing environments