Kushal Mishra
Appeals Representative
Delhi
Summary
Detail-oriented (claim and Appeals) associate with 3 years of experience in insurance claims processing. Proficient in reviewing, analyzing, and adjudicating claims within established policies and guidelines. Seeking to contribute expertise in claims management to a collaborative team environment in the insurance industry.
Overview
7
7
years of professional experience
2
2
Certificates
Work History
Appeals Representative
Optum Global Solution
06.2023 - Current
- Achieved higher success rates on appeal cases by closely analyzing denial reasons and crafting persuasive arguments for reconsideration on UNET , USP and FACETS Software.
- Assessed impact of union proposals on company or government operations.
- Tracking of the status for submitted appeals, ensuring timely follow-up and resolution.
- Negotiated with insurance carriers to find mutually agreeable solutions for disputed claims, contributing to higher customer satisfaction levels.
- Analyze and proceed for legal proceedings related appeals, providing documentation as required.
Claims Associate
Optum Global Solutions
04.2021 - 06.2023
- Processed existing claims reconsideration, on the basis of their approval, level of acceptance of benefits, High Dollar claims as daily Tasks and assigned the claims tickets via EWD Server.
- Provided quality customer service to assigned, insured and claimants throughout claim process to deliver timely service to customers.
- Supported risk management efforts by analyzing trends in claim data to identify potential areas of concern or opportunity for improvement.
- Enhanced claim processing efficiency by streamlining workflows and implementing new software tools.
- Processed and recorded new policies and claims according to applicable benefits over UNET.
- Implemented quality control measures for claims assessment, resulting in fewer errors and greater accuracy in decision making.
Customer Care Associate
Shoppers Stop
12.2016 - 09.2020
- Enhanced customer satisfaction by addressing and resolving issues promptly and professionally.
- Monitored cash drawers in multiple checkout stations and maintained adequate cash supply.
- Followed-through on all critical inter-departmental escalations to increase customer retention rates.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Resolved service failures, coordinated return appointments and executed referrals to specialists.
- Provided exceptional service by consistently meeting or exceeding key performance indicators.
Education
B.A -
University of Delhi
Higher Secondary - undefined
National Institute of Open Schooling
Matriculation - undefined
Sarvodaya Bal Vidyalaya
Skills
Accomplishments
- Awarded with Bravo for performance., 09/2022
- Awarded with Bravo for performance., 10/2022
Disclaimer
I solemnly declare that all the information furnished in this resume is in accordance with facts or truths to my knowledge. I take full responsibility for the correctness of the said information.
Certification
SQL- MySQL for Data Analytics and Business Intelligence
Hobbies
Bike Riding
Gym
Swimming
Listening Songs
Timeline
Data Analytics and Visualization Job Simulation
04-2024
Appeals Representative
Optum Global Solution
06.2023 - Current
SQL- MySQL for Data Analytics and Business Intelligence
05-2023
Claims Associate
Optum Global Solutions
04.2021 - 06.2023
Customer Care Associate
Shoppers Stop
12.2016 - 09.2020
B.A -
University of Delhi
Higher Secondary - undefined
National Institute of Open Schooling
Matriculation - undefined
Sarvodaya Bal Vidyalaya
Similar Profiles
UdayKiran KancharlaUdayKiran Kancharla
Senior Software Technical Lead at Optum Global Solution Pvt LtdSenior Software Technical Lead at Optum Global Solution Pvt Ltd
Prakhar KumarPrakhar Kumar
Manager Software Engineering (Data Science) at Optum Global Solution Pvt LtdManager Software Engineering (Data Science) at Optum Global Solution Pvt Ltd
SYED ATHERSYED ATHER
CLAIM ASSOCIATE at optum global solution india Private LimitedCLAIM ASSOCIATE at optum global solution india Private Limited