Mayur Nikam

6 years of experience in claims review and processing, specialising in group medical claims, group personal accident claims, and group term life claims

- Proven track record of accurately reviewing and analyzing claims, identifying discrepancies, and resolving issues promptly.

- Strong knowledge of insurance policies, regulations, and industry guidelines.

- Exceptional attention to detail, ensuring accuracy and completeness of claim documentation. - Excellent communication and interpersonal skills, collaborating effectively with internal teams and external stakeholders.

- Proficient in using claims management software and tools.

- Conducted comprehensive review and analysis of insurance claims to ensure compliance with company policies and industry regulations.

- Verified claim documentation, including medical records, invoices, and supporting documentation, for accuracy and completeness.

- Identified discrepancies, errors, or potential fraudulent activities and initiated appropriate actions to resolve issues.

- Collaborated with internal teams, including claims adjusters, underwriters, and legal counsel, to gather additional information and resolve complex claims.

- Responded to inquiries from policyholders, healthcare providers, and other stakeholders regarding claim status, coverage, and reimbursement.

- Maintained detailed records and documentation of claims review activities, ensuring proper documentation and adherence to company policies.

- Assisted in the development and implementation of claims review processes and guidelines to improve efficiency and accuracy.

- Processed and reviewed insurance claims, ensuring accuracy and compliance with company policies and regulatory requirements.

- Verified policy information, coverage, and claim eligibility, and requested additional documentation as needed.

- Collaborated with policyholders, healthcare providers, and other stakeholders to gather necessary information and resolve claim-related issues.

- Adhered to established timelines and service level agreements to ensure timely processing and resolution of claims.

- Assisted in training and mentoring new claims processing team members, providing guidance on claim procedures and best practices.

- Participated in regular team meetings and professional development activities to stay updated on industry trends and regulations.

• Handled cash transactions accurately, ensuring proper accounting for daily financial reports.
• Monitored inventory levels of supplies at the front desk area, ordering replacements as necessary to maintain smooth operations.
• Reduced expenses by negotiating with vendors for cost-effective supply contracts and services.
• Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
• Assisted in onboarding new employees, providing training materials, and coordinating orientation schedules to ensure a smooth integration into the team.