Summary
Overview
Work History
Education
Skills
Timeline
Generic

Krishna Chaurasiya

Appeal Representative
GURGAON

Summary

As an Experienced Appeals Representative at UnitedHealthcare with one year of solid experience, I am a seasoned professional in managing and navigating the appeals process for denied health insurance claims. My expertise lies in efficiently evaluating denied claims, conducting thorough research, and presenting compelling appeals to secure favorable outcomes for our policyholders. My role is vital in ensuring compliance with regulatory standards and upholding the highest levels of customer service.

Overview

3
3
years of professional experience
6
6
years of post-secondary education

Work History

APPEAL REPRESENTATIVE

Optum
Gurgaon
09.2022 - Current
  • Examined case to initiate clinical review.
  • Completed documentation of final appeals or grievance determination using appropriate templates.
  • Rendered decision for non-clinical complaints using sound, fact-based decision making.
  • Obtained additional documentation required for case review.
  • Researched and resolved written complaints submitted by consumers and physicians or providers.
  • Entered appeal requests in appeals module.
  • Provided outreach for additional information for appeals and grievances.
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.

Education

10th - Hindi,English, Science,Social Science And Sanskrit

LBS HIGH SCHOOL
Village- Bagaura, Siwan, Bihar
03.2015 - 05.2016

12th - PCM

SDS COLLEGE CHAPRA
CHAPRA, BIHAR
06.2016 - 06.2018

Bachelor Of Business Administration - Business Administration And Management

Glocal University
Uttar Pradesh
07.2019 - 07.2022

Skills

    Critical Thinking

undefined

Timeline

APPEAL REPRESENTATIVE

Optum
09.2022 - Current

Bachelor Of Business Administration - Business Administration And Management

Glocal University
07.2019 - 07.2022

12th - PCM

SDS COLLEGE CHAPRA
06.2016 - 06.2018

10th - Hindi,English, Science,Social Science And Sanskrit

LBS HIGH SCHOOL
03.2015 - 05.2016
Krishna ChaurasiyaAppeal Representative