Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
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Pooja

Pooja

Senior Claims Representative
59 D, Pink Apt, Pkt-6, St-2, Nasirpur Dwarka Sector-1 A,

Summary

Results-driven claims representative with a passion for problem-solving and a commitment to providing exceptional customer service. Seeking a challenging role to leverage experience in effectively handling claims and ensuring client satisfaction. Dedicated to delivering prompt resolutions and maintaining positive relationships with clients. Proven track record of exceeding performance goals and consistently meeting deadlines.

Overview

2026
2026
years of professional experience
2
2
Languages

Work History

Senior Claims Representative

Genworth
06.2022 - Current
  • Expedited the approval process for genuine claims, maintaining a high level of trust among policyholders.
  • Reduced backlog of pending claims by introducing an effective triage system based on priority levels.
  • Managed a large caseload while maintaining strict deadlines and delivering consistent results under pressure situations.
  • Improved team productivity by providing ongoing training and support to junior claims representatives.
  • Provided exceptional customer service when addressing inquiries from clients regarding their claim status or policy coverage details.
  • As a member of the Payment Servicing Team, we make claim decisions and process payment of long-term care claims based on the claimant's policy and other information provided.
  • Responsible for incoming and outgoing calls to claimants, caregivers, facilities and other persons or entities involved in the claim to enhance the customer experience.
  • Accountable for recognizing and working within a structured environment with clearly defined Standard Operating Procedures, to ensure consistency of claims practices and resolution. Also, making complex decisions based on experience and sound judgment for situations not specifically defined in those procedures.
  • Mentored new hires on company policies and procedures, fostering a productive work environment within the team.
  • Followed up with customers on unresolved issues.
  • Developed in-depth understanding of insurance policies and procedures.
  • Processed and recorded new policies and claims.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Modified, updated and processed existing policies.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Collaborated with internal departments and external vendors to resolve claims.

Benefit Operation Administrator

Wipro
09.2018 - 05.2022
  • Our primary focus is administration of US Health & Welfare Benefits.
  • Experience in U.S Health & Welfare process (Annual enrolment, Payroll processing, COBRA and DBP processing and HIPAA etc).
  • Manages data quality checks on files/data we are send/receive to/from multiple vendors or end client.
  • Implementing SOPs for process development to achieve process Excellency through Quality reviews.
  • Handling of escalations that we receive from end-client or from participant.
  • Reconciling of all the contributions for payroll delivery.
  • Resolving errors/edits that generate in system after getting data from vendors.
  • Manages data quality checks on files/data we are getting/sending to client/vendors.
  • Help technical team by identifying potential production defects and submit via defect submission process.
  • Provide floor support in terms of Product Knowledge and Coaching and perform regular audits.
  • Ensure team is working to enhance participant level experience by providing proper issue resolution.
  • Daily work allocation and Monitoring on process TAT.
  • Generate daily/weekly/monthly SLA reports to share to leadership/manager.

Practitioner

Concentrix
04.2016 - 08.2018
  • Responding to customer queries in a timely (within SLA) and accurate way, via email.
  • I was part of escalation handling group, where I was responsible for performing audit on emails/chats that may lead future escalation. Main goal is to prevent any escalation.
  • Analyzing and highlighting the support needed from other internal teams to close email cases successfully.

Intern

The Delhi State Cooperative Bank Ltd.
  • Main job is to advise customers on bank services for their needs.
  • Resolve issues with banking services and accounts.
  • Present financial products and services to existing and prospective customers.
  • Perform administrative duties (e.g. entering data into banking software).
  • Proven experience as a personal banker; experience in sales or customer service is a plus.

Education

MBA - Finance

Sikkim Manipal University
Delhi
04.2001 -

Bachelor of Commerce -

University of Delhi
04.2001 -

XIIth -

CBSE Board
Delhi
05-2009

Xth -

CBSE Board
Delhi
05-2007

Skills

  • MS Excel(Pivot table, V Lookup)

  • Basic knowledge of SQL and Power BI

Personal Information

  • Father's Name: Mr. Satish Kumar
  • Date of Birth: 04/15/1992
  • Gender: Female
  • Nationality: Indian
  • Marital Status: Single

Timeline

Senior Claims Representative

Genworth
06.2022 - Current

Benefit Operation Administrator

Wipro
09.2018 - 05.2022

Practitioner

Concentrix
04.2016 - 08.2018

MBA - Finance

Sikkim Manipal University
04.2001 -

Bachelor of Commerce -

University of Delhi
04.2001 -

Intern

The Delhi State Cooperative Bank Ltd.

XIIth -

CBSE Board

Xth -

CBSE Board

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Pooja Senior Claims Representative