Kapish Kumar Agarwal
Hyderabad
Summary
Claims Specialist with close to 5 years of experience in insurance, specializing in claims analysis, risk assessment, and conflict resolution. Proven ability to manage complex claims efficiently while maintaining compliance and customer satisfaction. Recognized for strong communication skills, team collaboration, and a results-oriented approach in dynamic environments.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Senior Associate
Carelon Global Solutions
10.2023 - Current
- Led the evaluation of complex claims for accuracy and compliance with company policies and industry regulations.
- Mentored and trained junior claims associates, fostering professional growth and ensuring adherence to best practices.
- Analyzed claims data trends to identify opportunities for process improvements and reduce operational inefficiencies.
- Resolved high-priority and complex claim disputes through effective negotiation and stakeholder communication.
- Implemented quality control measures and workflow optimizations that significantly improved claim resolution times.
- Championed the adoption of new technologies and tools, enhancing claims processing speed and accuracy.
- Collaborated with cross-functional teams and external vendors to resolve challenging claims and improve customer satisfaction.
- Investigated subrogation opportunities, recovering funds and contributing to cost containment.
- Developed and delivered targeted training programs to enhance team capabilities in claims handling and system usage.
- Streamlined interdepartmental communication, resulting in increased efficiency and reduced claim-processing errors.
Associate
Carelon Global Solutions
12.2020 - 09.2023
- Healthcare Associate working at Carelon Global Solutions, focusing on serving people across the entire care journey & connecting them to the care, support, & resources they need to lead healthier lives.
- Collaborated with cross-functional teams to refine service delivery protocols.
- Analyzed operational processes to identify areas for efficiency improvements.
- Determined appropriateness of payers to protect organization and minimize risk.
- Maintained confidentiality of patient finances, records, and health statuses.
- Processed and reviewed claims to ensure compliance with company policies and regulatory requirements.
- Analyzed claim data to identify trends, discrepancies, and potential fraud for proactive case management.
- Streamlined documentation processes, reducing turnaround time for claim approvals and denials.
- Maintained up-to-date knowledge of industry regulations, ensuring compliance in all aspects of claims handling.
- Managed high-volume claim caseloads, ensuring accurate documentation and adherence to company policies.
- Worked productively in fast-moving work environment to process large volumes of claims.
Education
Bachelor of Commerce - Computers
Avinash College Of Commerce
Hyderabad, India11-2020
Intermediate - Commerce
Sri Medha V Jr College
Hyderabad, India03-2017
CBSE -
Bharatiya Vidya Bhavans Public School
Hyderabad, India03-2015
Skills
- Claims Auditing
- Collaborative decision making
- Problem-solving skills
- Microsoft Excel proficiency
- Business operations
- Collaborative team member
- Rapid skill acquisition
- Clear and concise email writing
- Engaging presentation skills
- Performance reporting
- Effective communication
- Workforce coordination
Certification
- CURES White Belt Certified
- PAHM Certified.
Hobbies
- Playing Badminton.
- Swimming.
- Watching movies or series.
- Playing video games
- Photography
Languages
English
Hindi
Telugu
Timeline
Senior Associate
Carelon Global Solutions
10.2023 - Current
Associate
Carelon Global Solutions
12.2020 - 09.2023
Bachelor of Commerce - Computers
Avinash College Of Commerce
Intermediate - Commerce
Sri Medha V Jr College
CBSE -
Bharatiya Vidya Bhavans Public School
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