Karthik G

• From November 2018 to September 2020, I worked as a Claims Associate
• From October 2020 to March 2023, I worked as an Associate Business Analyst.
• From April 2023 onwards, I will be working as a Business Analyst.

Roles and Responsibilities for Claim Associate and Business Analyst.

• Started adjudicating the facility and professional claims with accuracy.
• Auditing the claims for the nesting phase employees and giving the feedback on the mistakes.
• Connecting with operation exports with regards to clarification/updates on a weekly basis.
• Provided the training for the new hire.
• Reviewing the enterprise-level errors and rebutting the errors to meet the accuracy.
• Have knowledge of the Agile process.
• Supporting the CI&W lights-on team, the CI&W application team, and PEGA for the last four years. I am working on both PEGA and CI&W functionality, and further working on the CI&W/PEGA application and settings.
• Collecting the claims edit details, preparing the workflow, and sharing it with the IT team to help them develop the CI&W application.
• Performed UAT testing and supported a few projects.
• Assisting the user in identifying the CI&W/PEGA application errors.
• Working on Jira and incidents that are related to the CI&W application.
• Conducting a working session with users to identify the CI&W/PEGS errors.
• Assisting IT to resolve Jira issues created for CI&W/PEGA.
• Requirements gathering, designing, coding, testing, deployment, and maintenance.
• Created and reviewed many training documents, which are appreciated by the client.
• Capable of taking on all types of challenges and handling the client requirements very well.
• Process excellent client coordination, and be involved in various related activities, such as attending the project kickoff meeting, preparing and sending daily and weekly status reports to stakeholders of projects, and addressing queries to the project.
• Expertise in creating system test plans, test strategies, and test cases.
• Strong domain experience in the healthcare industry, especially in claims systems.

• Authenticating the claims as per HGS guidelines.
• Maintain the TAT of individuals and team members.
• Resolving the queries of the team members.
• Handling urgent and escalated emails.
• Conducting refresher training on a monthly basis (new updates, production, and error details).
• Assigning files and consolidating the status.
• Provide training to new members and updating the desk procedures regularly
• To Impart training and assist junior claim examiners on the job training identifying process improvement opportunities and reporting the same to the supervisor
• Update and maintain, quality reports and submit to the supervisor
• Preparing reports of project details at the month end