Karthik Reddy
Hyderabad
Summary
US healthcare professional with 3+ years of experience in client-facing support, benefits administration, COBRA operations, eligibility and benefits verification, and claims processing. Proven expertise in handling high-volume member, employer, and HR queries via chat and email, while ensuring HIPAA compliance, SLA adherence, and high-quality resolution. Experienced in administering U.S. Benefits programs, including medical, dental, vision, life insurance, disability, FSA, HSA, HRA, and leave programs. Strong in case ownership, escalations, audit readiness, and cross-functional coordination. Recognized for maintaining 98% QA and resolving tickets with accuracy, empathy, and compliance.
Recognized for delivering exceptional customer service through phone, chat, and email interactions, while maintaining professionalism, empathy, and strong communication. Skilled in using CRM tools, RA substantiation platforms, and payer systems to enhance process efficiency and customer satisfaction. Committed to quality, timely service delivery, and continuous process improvement.
Overview
4
4
years of professional experience
Work History
Benefits Administration Services Associate II
CONDUENT
Hyderabad
10.2023 - 11.2025
- Provided end-to-end client support for the U.S. Healthcare benefits administration, handling high-volume member, employer, and HR inquiries through chat and email, while maintaining strict SLA adherence.
- Administered and supported by the U.S. Benefits programs, including Medical, Dental, Vision, 401(k), FSA, HSA, HRA, and LPFSA. Performed eligibility and benefits verification across plan types, including HMO, PPO, EPO, and POS, ensuring accurate coverage details and benefit interpretation.
- Initiated and supported healthcare claims adjudication by validating eligibility, coverage, authorization requirements, CPT/ICD alignment, and benefit applicability before processing.
- Handled claims-related inquiries involving deductibles, copays, coinsurance, accumulators, and out-of-pocket maximums, ensuring accurate resolution or routing.
Managed appeals and grievances by reviewing denied claims, validating documentation, coordinating with internal claims, medical review, and policy teams, and tracking appeal outcomes within defined TAT. - Supported COBRA qualifying events, including enrollments, terminations, premium billing inquiries, and continuation coverage, are in compliance with federal regulations.
Ensured strict adherence to HIPAA and PHI guidelines, maintaining confidentiality, and audit-ready documentation at all times.
Owned cases end-to-end from intake to closure, including follow-ups, escalations, and resolution communication. - Collaborated with operations, QA, backend, and policy teams to resolve escalations, and prevent repeat issues.
- Consistently achieved 98% QA scores while resolving ticket cases with accuracy and empathy.
BFSI Customer Service
Tech Mahindra
Hyderabad
01.2023 - 08.2023
- Dedicated and empathetic Customer Service Representative with proven experience in resolving customer issues efficiently and professionally across email, and chat support in healthcare. Skilled in handling high-pressure situations, managing customer expectations, and delivering exceptional service that boosts customer satisfaction and loyalty. Proficient in CRM tools like Ubona, Avaya, Ada AI, Zendesk and communication platforms like Chanty. Committed to creating a positive customer experience by providing prompt, clear, and helpful solutions.
- Maintained an average customer satisfaction score of 95% through timely, empathetic, and effective chat/email responses.
- Used Ubona, Zendesk and Gmail to manage support tickets, track issue resolution, and escalate when necessary.
- Delivered clear and professional written communication while troubleshooting customer issues and guiding them through step-by-step solutions.
- Handled multiple live chat sessions simultaneously, ensuring accuracy and speed without compromising quality.
- Collaborated with internal teams through Slack to resolve customer issues quickly and maintain service quality.
- Responded to 27+ customer emails and chat inquiries daily, resolving issues related to status of claim to healthcare.
- Provided excellent service and attention to customers when face-to-face or through mail and chat support.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Executive Sales Associate
PPS Motors Private Limited Volkswagen
Hyderabad
07.2021 - 02.2022
- Managed daily operations to ensure efficient workflow and customer satisfaction.
- Coordinated with sales teams to align marketing strategies and promotional activities.
- Assisted with customer requests andMaintain Records of all backend Sales & uploading answered questions to improve satisfaction.
- Worked with cross-functional teams to achieve goals.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Maintains enquiry records with the Backend Team
Education
Associate of Science - Computer Data Science & Data Analytics Engineering
LOYOLA ACADEMY DEGREE & PG COLLEGE
Hyderabad 04-2020
High School Diploma -
NARAYANA JUNIOR COLLEGE
Hyderabad 03-2017
KENDRIYA VIDYALAYA
Hyderabad 05-2015
Skills
US healthcare operations
Benefits administration
- Eligibility verification
- Claims processing
- Appeals management
- Claims review and adjustments
- COBRA administration
- FSA and HSA management
Compliance and regulations
- HIPAA compliance and payer guidelines
- Client support and case management
- Case escalation, SLA, and TAT management
Tools and systems
- Salesforce CRM, Zendesk, Avaya, Ubono, ADA AI tools
- Case management systems like RA substantiation tools
Hobbies and Interests
- Learning about US healthcare policies and benefits updates
- Problem-solving through case analysis and claims scenarios, reading about healthcare compliance and data privacy standards
- maintaining a healthy lifestyle through walking and basic fitness
Disclaimer
I hereby declare that all the information provided above is true and correct to the best of my knowledge and belief
Personal Information
Languages
English
Proficient (C2)
C2
Hindi
Advanced (C1)
C1
Telugu
Native
Native
Timeline
Benefits Administration Services Associate II
CONDUENT
10.2023 - 11.2025
BFSI Customer Service
Tech Mahindra
01.2023 - 08.2023
Executive Sales Associate
PPS Motors Private Limited Volkswagen
07.2021 - 02.2022
Associate of Science - Computer Data Science & Data Analytics Engineering
LOYOLA ACADEMY DEGREE & PG COLLEGE
High School Diploma -
NARAYANA JUNIOR COLLEGE
KENDRIYA VIDYALAYA