Nikita Bhuyankar
Mumbai
Summary
Results-driven Claims Manager specializing in claims management and team leadership. Streamlined processes and ensured compliance while effectively resolving escalations. Focused on policy interpretation, KPI optimization, and system enhancements to improve operations. Trained teams and collaborated with insurers to boost productivity and expedite claims turnaround.
Overview
1
1
Language
8
8
years of professional experience
Work History
Claims Manager
Procentris(Expa TPA)
Mumbai
09.2026 - Current
- Managed claims operations for Expa TPA clients across medical and benefit programs.
- Managed International Private Medical Insurance (IPMI) claims across multiple regions.
- Supervise a team of claims processors, ensuring accuracy and compliance.
- Directed claim handlers through escalations, inquiries, and resolution steps.
- Enhanced team productivity to ensure consistency and reduce claims and preauthorisation ageing.
- Monitored ongoing claims to adjust reserves, and ensure accurate reporting.
- Resolved escalated customer issues by delivering timely and effective solutions.
- Prepared detailed reports on claim status and activities for management review.
- Monitored claim workflows in Expa TPA systems to maintain service standards.
- Coordinated with providers, members, and employers on claim investigations.
- Developed processes for tracking open cases and monitoring progress towards resolution goals.
- Collaborated with other departments to investigate potential coverage disputes or discrepancies.
- Conducted regular audits of the department's performance metrics to ensure accuracy.
- Identified potential fraud cases by conducting investigations into suspicious activity.
- Assisted in developing strategies for reducing losses due to fraudulent or exaggerated claims.
Claims Supervisor
Bayzat
Mumbai
02.2023 - 09.2026
- Supervise a team of claims processors, ensuring accuracy and compliance.
- Resolve escalated claims, oversee KPIs, and implement process improvements.
- Managed International Private Medical Insurance (IPMI) claims across multiple regions.
- Conducted training for new joiners and mentored junior staff on policy interpretation and systems to improve team competency.
- Enhance team productivity to maintain consistency, and to reduce claims and preauthorisation ageing.
- Strengthened insurer partnerships to expedite claims processing.
- Enhanced team productivity to ensure consistency and reduce claims and preauthorisation ageing.
- Supported audits, internal reporting, and client escalations.
- Participated in regular team meetings to discuss challenges and share insights on improving service delivery.
Senior Claims Analyst
Bayzat
Mumbai
03.2021 - 02.2023
- Processed complex, high-value claims, maintaining a minimal error rate to ensure accuracy.
- Collaborated with IT and product teams to enhance claims systems, improving user experience.
- Managed complaints with clear communication and problem-solving, ensuring resolution and customer satisfaction.
- Collaborated with IT/product teams to enhance claims systems.
- Managed complaints with calm, clear communication and problem-solving.
- Demonstrated consistent hard work and dedication to achieve results and improve operations.
- Trained and mentored employees to maximize team performance.
Claims Analyst
Bayzat
Mumbai
04.2019 - 03.2021
- Reviewed and processed claims to ensure accuracy and adherence to policy coverage, enhancing customer trust.
- Coordinated with clients and healthcare providers to gather necessary documentation, facilitating timely claim resolution.
- Maintained organized claim records while supporting initiatives to streamline processing workflows.
- Coordinated with clients and healthcare providers to obtain documentation.
- Maintained claim records and supported efficiency initiatives.
Education
Master - Computer Science
Mumbai University
MumbaiSkills
- Claims management
- Claims processing
- Policy interpretation
- Regulatory Compliance
- Compliance management
- Claims administration
- Health Insurance
- Reporting & Documentation
- Data assessment
- KPI monitoring
- Process improvement
- System optimization
- Team Leadership
- Client escalation resolution
- Conflict Resolution
- Issue resolution
- Performance evaluation
- Claims management
Timeline
Claims Manager
Procentris(Expa TPA)
09.2026 - Current
Claims Supervisor
Bayzat
02.2023 - 09.2026
Senior Claims Analyst
Bayzat
03.2021 - 02.2023
Claims Analyst
Bayzat
04.2019 - 03.2021
Master - Computer Science
Mumbai University