GAURAV KUMAR TANK
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5 years of insurance experience.
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
5
5
years of professional experience
Work History
Claims Representative
Optum Global Advantage
11.2018 - Current
- Maintained accurate and up-to-date records of claim information for future reference.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
- Determined appropriateness of payers to protect organization and minimize risk.
- Communicated verification and authorization status updates with department to facilitate decision-making for patient admissions and insurance coverage.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Checked documentation for accuracy and validity on updated systems.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Updated claims system to track claim status and provide relevant information to other department.
- Worked productively in fast-moving work environment to process large volumes of claims.
Education
BACHELORS OF COMMERCE (ACCOUNTS HOUNS.) -
VINOBA BHAVE UNIVERSITY HAZARIBAGH (JHARKHAND)
01.2014
12TH -
DVC PLUS TWO HIGH SCHOOL JAC BOARD RANCHI (JHARKHAND)
01.2011
10TH -
DVC PLUS TWO HIGH SCHOOL JAC BOARD RANCHI (JHARKHAND)
01.2009
Skills
- Interpersonal Communication
- Claims Investigation
- Coverage Determination
- Policy Understanding
- Team Collaboration
- Data Analysis
- Liability and Damage Assessment
- Insurance Claims Review
- Decision-Making
- Documentation Review
Company Description
UnitedHealth Group incorporated an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers healthcare products and insurance services.
Company
Optum Global Advantage
Personal Information
- Date of Birth: 02/01/1993
- Marital Status: Unmarried
Timeline
Claims Representative
Optum Global Advantage
11.2018 - Current
BACHELORS OF COMMERCE (ACCOUNTS HOUNS.) -
VINOBA BHAVE UNIVERSITY HAZARIBAGH (JHARKHAND)
12TH -
DVC PLUS TWO HIGH SCHOOL JAC BOARD RANCHI (JHARKHAND)
10TH -
DVC PLUS TWO HIGH SCHOOL JAC BOARD RANCHI (JHARKHAND)
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