Dr. Sooraja Baburaj
Claims Specialist
Bangalore
Summary
Experienced in settlement preparation, claims processing, and appeal filing, a tactful Claims Specialist excelling in handling complex liability claims. With a diplomatic and personable approach, skilled in managing sensitive and confidential information while ensuring customer satisfaction. Committed to contributing to the success of the company, dedicated to maintaining high standards of professionalism and delivering exceptional results.
Overview
5
5
years of professional experience
Work History
Claims Specialist
Acko General Insurance
Bengaluru
12.2022 - Current
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Conducted detailed investigations into suspicious claims, successfully identifying and addressing fraudulent activities.
- Provided expert advice on complex claim issues, aiding in resolution of high-stakes disputes.
Medical Officer
Mediassist TPA
Bengaluru
12.2021 - 12.2022
- Medical claim adjudicator
- Review complex claims and incidents to assess correct response
- Assisted senior staff with overseeing department procedures
- Followed up with customers on unresolved issues.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Minimized financial losses by identifying and addressing fraudulent claims through rigorous investigation and analysis.
Ayurvedic Consultant
Health Total By Anjali Mukerjee
12.2019 - 03.2021
- Hospital Management
- Administration and Patient Care
Education
BAMS -
SDM College of Ayurveda And Hospital
Hassan, India 04.2001 -
HIGHER SECONDARY SCHOOL -
Chinmaya Vidyalaya
Payyanur, KeralaS.S.L.C -
Chinmaya Vidyalaya
Payyanur, KeralaSkills
- Handling medical insurance claims
- Processing medical insurance claims
- Health insurance knowledge
- Managed care principles
- Leadership ability
- Communication skill
- Settlement determinations
- Claims analysis
- Claims investigation
Timeline
Claims Specialist
Acko General Insurance
12.2022 - Current
Medical Officer
Mediassist TPA
12.2021 - 12.2022
Ayurvedic Consultant
Health Total By Anjali Mukerjee
12.2019 - 03.2021
BAMS -
SDM College of Ayurveda And Hospital
04.2001 -
HIGHER SECONDARY SCHOOL -
Chinmaya Vidyalaya
S.S.L.C -
Chinmaya Vidyalaya
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