Kavya H
Bengaluru
Summary
Detail-oriented Claims Associate with 3 years of experience in U.S. healthcare insurance claims processing. Manages intake, eligibility review, and payment submission, ensuring policy accuracy and timely resolution. Reviews discrepancies, applies client requirements, and escalates issues through RTM chat platforms, while effectively handling high-priority and aged claims.
Overview
3
3
years of professional experience
Work History
Claims Associate
Carelon Global Solutions
Bengaluru
06.2023 - Current
- Analyze and verify claims to determine approval or denial in accordance with insurance guidelines.
- Process healthcare claims based on eligibility and policy criteria.
- Manage high-priority and aged claims to maintain operational efficiency.
- Resolved complex claims inquiries, improving customer satisfaction through effective communication.
- Managed case closures to ensure compliance with client specifications and timely processing.
- Coordinated with internal teams via RTM chat platforms for claims resolution and issue escalation.
- Trained new associates on claims processing system, fostering a knowledgeable and competent team environment.
- Supported the Infinity project for AI-assisted U.S. healthcare claims operations.
Education
Bachelors of commerce -
Triveni institute of commerce and science
01-2022
Pre-university course - commerce
Soundarya composite PU college
01-2019
10th -
Sharada Vidyalaya high school
01-2017
Skills
- Wellpoint group system
- CIW
- Bluesquare
- FileNet
- Excel
- PowerBI
- Basic SQL
- Microsoft office tools
Languages
- Kannada
- English
Personal Information
- Date of Birth: 06/01/01
- Marital Status: Unmarried
- Religion: Hindu
Father's Name
Hanumaiah
Timeline
Claims Associate
Carelon Global Solutions
06.2023 - Current
Bachelors of commerce -
Triveni institute of commerce and science
Pre-university course - commerce
Soundarya composite PU college
10th -
Sharada Vidyalaya high school