GAYATRI PRADHAN

I am responsible for claim adjudication with adhering all the Parameters of Quality and achieving the optimum score of Productivity. along with there are few more my core responsibilities are motioned below-

• Reviewed and processed insurance claims by evaluating documentation and applying company policies and guidelines.
• Communicated effectively with clients regarding claim statuses, denials, and the appeals process, enhancing customer satisfaction.
• Identified trends in claims data and recommended improvements to reduce error rates and optimize operational efficiency.
• Participated in training sessions to stay updated on industry regulations and advancements in claims processing technology.
• Provided training and mentorship to new employees on best practices in claim adjudication procedures.
• Established and maintained an organized filing system for processed claims to ensure quick retrieval and accuracy of records.
• Developed and maintained strong relationships with both internal teams and external stakeholders to facilitate claim resolution.
• Specialized in interpreting complex insurance policies and determining coverage eligibility for various medical claims.
• Claim Adjudication.
• Worked with M&R Appeals Nice Team.
• Policy Interpretation.
• Denial Management.
• Co-ordination of Benefit.
• Analysis of all kinds of Paper claims, Clinical notes and Other Insurance.

• Company Overview: USHA International is a old company that aims to provide good quality branded products, as well as doorstep repairing service to existing customers
• At USHA International, we strive to achieve the highest level of 'Customer Satisfaction' possible
• Preparing Daily MIS
• Dealer wise Customize Summary
• State Wise Summary
• Product Wise Summary
• Ad-Hoc Report as per requirement Management
• USHA International is a old company that aims to provide good quality branded products, as well as doorstep repairing service to existing customers
• At USHA International, we strive to achieve the highest level of 'Customer Satisfaction' possible