Pallavi R
Bengaluru
Summary
Seasoned claims processing specialist with 5+ years of work experience across health, travel and property casualty insurance sectors I excel in overseeing complete claims processes, conducing meticulous investigations, and upholding compliance standards. Expertise in maintaining data accuracy, analyzing medical and police records and facilitating prompt claim settlements. Known for effective communication skills. Adeptly handling escalated claims while boosting operational efficiency through collaborative efforts and superior service delivery.
Overview
8
8
years of professional experience
Work History
Claims Management Analyst
Accenture
08.2023 - Current
- Managed the entire claims processing lifecycle and customer servicing for health, property casualty and travel insurance.
- Handled claims for Amex clients providing daily reports on outstanding claims to management.
- Maintained meticulous records during analysis to uphold data integrity and regulatory compliance.
- Conducted thorough investigations into insurance claims, assessing coverage and liability, and preparing detailed reports to recommend claims approval or denial.
- Analyzed medical records and police reports pertinent to claims ensuring comprehensive assessment.
- Consistently met turnaround time targets while prioritizing customer satisfaction.
- Set reserves for claims based on projected settlement costs to ensure financial accuracy.
- Evaluated and adjusted claims to ensure equitable and prompt settlements.
- Investigated potentially fraudulent claims with focus on thoroughness, quality and risk mitigation.
- Reviewed documentation for both denied and accepted claims to ensure adherence to policies.
- Facilitated immediate cashless approvals for emergency surgeries after verifying coverage and addressing additional client needs.
- Handling escalation and denial claims by thoroughly explaining policy T&C to insured.
Specialist - Claims
Acko General Insurance
11.2019 - 08.2023
- 3+ years of experience in handling health, travel, property and casualty claims.
- Handled end-to-end claims processing.
- Processing, Maintaining data and preparing reports(payment file, closed with paid) and sending it to vendors on timely basis.
- Maintaining turn around time(TAT) without hampering customer/vendor experience.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Connecting with partners on regular basis regarding queries and other process update(B2B).
- Maintained ongoing contact with customers/vendors throughout claim process diligently and accurately reporting progress.
- Resolved problems, improved operations and provided exceptional service.
- Providing training to team members and handling escalations.
Operations Executive - GI
Bajaj Capital Limited
03.2018 - 11.2019
- Coordinated with all 8 branches to oversee data management, new business, and renewals.
- Prepared monthly reports and collaborated with headquarters on claims performance.
- Worked on Motor Insurance, Health insurance and Travel Insurance.
Trainee Engineer
Bharat Electronics Limited
11.2016 - 11.2017
- One Year Training In Bharat Electronics Limited and have Hands On Experience In Designing And Testing Of Transformers
- Trained in areas like quality assurance, production, and coil winding.
Education
Bachelor of Engineering - Electrical And Electronics
Sri Krishna Institute Of Technology
05-2016
Skills
- Excel
- Adaptability,Team Work
- Claim Investigation
- Insurance Documention
- Risk Management
- Settlement Determinations
- Claim Amount Calculations
- Policy Modifications and Updates
- Problem-Solving
- Customer Service
- Insurance Claim Forms Review
- Verbal and Written Communication
- Insurance Carrier Applications
- Teamwork and Collaboration
- Microsoft Office
- Payment and Investigation Escalations
- Financial Transactions
- Time Management
- C (Programming Language)
- SQL
Accomplishments
Best Performer Award for the month of March 2020
Best Performer Award for the month of September 2020
Best Performer Award for the month of November 2020
Best Performer on quarterly basis (April, May, June -2021)
R&R, Best performer on quarterly basis(August, September, October-2022)
Languages
English
Proficient
C2
Hindi
Proficient
C2
Kannada
Proficient
C2
Timeline
Claims Management Analyst
Accenture
08.2023 - Current
Specialist - Claims
Acko General Insurance
11.2019 - 08.2023
Operations Executive - GI
Bajaj Capital Limited
03.2018 - 11.2019
Trainee Engineer
Bharat Electronics Limited
11.2016 - 11.2017
Bachelor of Engineering - Electrical And Electronics
Sri Krishna Institute Of Technology