Efficient Senior Claims Processor known for high productivity and ability to complete tasks swiftly. Possess specialized skills in claims adjudication, regulatory compliance, and process improvement. Excel in critical thinking, problem-solving, and communication, ensuring smooth workflow and client satisfaction.
Overview
9
9
years of professional experience
Work History
Senior Claims Processor
NTT DATA
Gurgaon
01.2020 - Current
Ensured that all HIPAA privacy rules were followed when handling sensitive information.
Resolved complex claims issues requiring research and analysis of policy language, state laws, and industry standards.
Investigated customer complaints related to claim adjudication process or outcomes.
Identified discrepancies in claim information and requested additional documentation from providers.
Analyzed provider bills for accuracy, completeness, and conformance with established guidelines.
Maintained detailed records of all claims activity including payments made, denials issued, appeals filed.
Monitored changes in regulatory requirements impacting the claims payment process.
Evaluated the medical necessity of services provided by physicians, hospitals, and other healthcare providers.
Provided guidance to junior staff regarding claim processing procedures or technical issues.
Verified coverage eligibility for members through review of insurance contracts and benefit plans.
Senior Customer Service Associate
Concentrix Daksh India Pvt LTD
Gurgaon
09.2015 - 10.2017
Identified opportunities for process improvements within the customer service department.
Identified potential areas of improvement within customer service operations and communicated recommendations to management team.
Collaborated with management teams to develop strategies for improving customer service processes.
Utilized a variety of software applications to respond quickly to customer queries.
Assisted customers in navigating website features, enabling them to find products easily.
Reported any unresolved product issues or discrepancies to supervisor immediately.
Director - Cloud & Infrastructure Services at NTT DATA Services (Previously NTT/Netmagic)Director - Cloud & Infrastructure Services at NTT DATA Services (Previously NTT/Netmagic)
Service Desk Analyst / Acting Shift Lead at NTT GDC India Private Limited / NTT DataService Desk Analyst / Acting Shift Lead at NTT GDC India Private Limited / NTT Data