Gaurav Charnalia

Ensuring that the TAT for the various corporate and activity (Escalated Claims, Enrollment Error, Payment)

Handle Iffco Tokio General Insurance (Health-Grievance).

Communicating with healthcare providers, clients, and insurance companies to obtain necessary information.

Document, track, and trend findings per organizational guidelines.

Audit daily processed claims through random selection, based on set criteria.

Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational policies.

Assist Broker claim team with navigating medical claims, including inquiries about submissions, rejections, and procedures.

Provide accurate and detailed information about claim processes, documentation requirements, and insurance coverage.

Collaborate with internal departments, like claims processing, to address complex issues and expedite resolutions.

Maintain extensive knowledge of all insurance products, medical billing codes, and claim procedures.

Document customer interactions and update records accurately in our system.

Identify and escalate critical or unresolved issues to the appropriate supervisor.

Adhere to company policies, procedures, and compliance guidelines.

Knowledge of medical terminology, insurance claim procedures, and billing codes.

Explaining clients on the policy terms related queries over the call or mail.

Reviewing denial claims sent by TPAs and ensuring that denial is done as per policy terms.

Resolving CKYC Error.

Other duties as assigned by senior management.

Projects:

1) Prudent Insurance Brokers Private Limited: April 2023 to March 2024.

Provide the day-to-day solution. Denial review awaited cases.

Explaining the policy terms related queries over the call or mail.

Handle members of broker employee benefit claims query and provide solution.

Investigate and resolve concerns with a focus on high satisfaction and clear communication.

Resolve the payment error.

2) IFFCO Tokio General Insurance Limited, December 2022 to January 2023.

i. Handling the claims audit.

ii. Resolving claim payments and errors.

iii. Account details updating and uploading in the system.

iv. Handle Grievance Mail (Bhima Bharosa)

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