Gaurav Vijaypuria
Claims Representative Associate
Delhi
Summary
Detail-oriented and analytical problem-solver with a strong foundation in effective communication and interpersonal skills. Proven expertise in interviewing claimants, compiling comprehensive records, and meticulously documenting findings to ensure accuracy and compliance with insurance policies and standards. Qualified Claims Representative skilled in investigating claims, verifying information, and managing settlements efficiently. Friendly and upbeat team player who approaches tasks with organization and discipline, bringing 3 years of valuable experience in the insurance industry.
Overview
3
3
years of professional experience
2
2
Languages
Work History
CLAIM REPRESENTATIVE ASSOCIATE
Optum Global Solution Pvt. Ltd.
02.2023 - Current
- Accurately and efficiently processed a high volume of medical claims (e.g., inpatient, outpatient, professional) ensuring timely and accurate reimbursement.
- Handled assigned cases promptly, resolving issues by working on member data.
- Advanced analytical skills, ability to analyze problems and provide appropriate solutions.
- Resolved customer inquiries regarding claim status, payments, and denials in a timely manner.
- Prepared adjustment documents for processing of payments or denials of claims.
- "Identified and resolved complex claim issues through effective research and problem-solving."
- Correcting the claim submission to ensure it is complete and accurate for processing.
- Processed and analyzed Coordination of Benefits (COB) claims to ensure accurate determination of primary and secondary payer responsibilities.
- Ensured adherence to HIPAA and company compliance standards while managing sensitive claim information.
- Performed claim adjustments on rework cases by reviewing denied or returned claims, identifying discrepancies, and applying necessary corrections to ensure accurate resubmission and timely reimbursement for providers.
Education
Bachelor of Arts (B.A.) - Political Science
Delhi University (SOL)
Delhi01-2022
Intermediate - undefined
Sunrise Senior Secondary Public School
Uttarakhand05-2018
High School - undefined
Disha Convent
Uttarakhand05-2016
Skills
Claims analysis
Proficient in Microsoft Office
Effective time management
Document organization
Quality assurance in documentation
Claims assessment expertise
Effective team collaboration
Effective problem resolution
Interests
Reading and Listening songs, Playing Cricket, Dancing
Timeline
CLAIM REPRESENTATIVE ASSOCIATE
Optum Global Solution Pvt. Ltd.
02.2023 - Current
Intermediate - undefined
Sunrise Senior Secondary Public School
High School - undefined
Disha Convent
Bachelor of Arts (B.A.) - Political Science
Delhi University (SOL)