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
Data Entry
Grievance handling
MS Office
Problem-Solving
Teamwork and Collaboration
Interpersonal Communication
Self-Motivated
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