PRATEEK SHARMA
Shahjahanpur
Summary
Results-driven professional with extensive experience in claim processing and absence management at Conduent Business India LLP. Proficient in data analysis and quality auditing, I excel in ensuring data integrity while providing exceptional customer service. Recognized for training new team members and enhancing operational efficiency through effective policy reviews.
Overview
11
11
years of professional experience
Work History
Analyst
Conduent Business India LLP
Noida
12.2021 - Current
- Adjusted direct billing based on balances of FMLA, Military Leave, Sick Leave, and other paid leaves to ensure accurate billing.
- Processing the STD and Absence Management Claims.
- Processing the monthly COBRA billing.
- Facilitated monthly transfer of premium funds to maintain financial accuracy and compliance.
- Handled the processing of premium refunds.
- Calculating deductions in arrears and billing letters for those who are on leave of absence.
- Confirmed hours, earnings, and eligibility for FMLA and other leave types to support employee leave management.
- Auditing the processed transactions by the team.
- Provide the training for the new joiner.
- Maintained accurate records of all data collected during analysis processes.
Process Associate
Genpact India Pvt Ltd
Gurgaon
11.2019 - 12.2021
- Managed processing of STD, SDI, and absence management claims to ensure compliance with company policies.
- Followed FMLA guidelines to process claims for employees on FMLA leave.
- Reviewed related documents including Policy Contract, Group JA, ER statement, and Attending Physician Statement for accurate processing of STD and SDI claims.
- Compiled Claim Summary with initial claim decision upon receipt of all required documents.
- After reviewing these documents, we found the following details: Eligibility Period, Enrollment Period, Benefit Waiting Period, Policy Exclusions, Policy Limitations, EE's Class, Policy Effective Dates, Maximum Benefit Period, Policy Contribution, Maximum Payable Benefit, Minimum Payable Benefit, and many more.
- But for the absence claims, we need to refer only to the group-specific JA and health certificate.
- In absent management claims, we also review which kind of leave the employee has.
Claim Associate
Optum Global Solutions
Gurgaon
10.2018 - 06.2019
- Retrieved missing EOBs, identified misdirected payments, and issued refunds to patients or insurance companies.
- Processed denials and manual EOBs, posting payments accurately to patient accounts.
- Reconciled payment batches to ensure accuracy and completeness after posting.
Sr Executive
EXL Services
Noida
07.2015 - 09.2018
- Processed all policyholder requests, including banking information updates, premium adjustments, refunds, and confirmation letter dispatch, ensuring compliance with policy terms.
- Managed multiple types of individual life insurance policies, including term, whole life, universal life, variable life, and variable universal life, facilitating comprehensive client coverage.
- Apart from that, here we also handled STD claims.
- For processing the claim, we need to read the Policy Contract, Group-specific JA, Employer Statement, and all Medical Documents that are received from the Employee and Employer.
- When we receive all the necessary information from the employee and employer, we create the claim summary and upload it with the appropriate decision, such as whether the claim will be denied or approved.
- Provide training to new joiners.
- Give assistance to all team members in both teams.
- Assigned tasks to team members to ensure workflow efficiency.
- Conducted quality audits for team members in GI invoicing, identifying areas for improvement and enhancing overall accuracy of financial documentation.
Education
Master of Arts - Economics
MJP Rohilkhand University
Bareilly, UP, India06-2015
Bachelor of Arts - Economics
MJP Rohilkhand University
Bareilly, UP, India06-2013
Intermediate Certificate - Math
UP Board
Allahabad06-2008
High School Diploma -
UP Board
Allahabad06-2006
Skills
- Claim processing
- Policy review
- Leave management
- Quality auditing
- Report generation
- Complex data analysis
- SQL and databases
- Excel proficiency
- Data integrity assurance
- Data entry
- Process improvement
- Customer service
- Team training
- Adaptability
- Consistent results
Languages
Hindi: First Language, English: B2, Upper Intermediate (B2)
Accomplishments
- 10 Times Monthly performer in Conduent
- 6 Times Monthly performer in Genpact
- 1 Time Annual, 3 Time Quarterly and 9 Times Monthly performer in EXL
DECLARATION
I hereby declare that the above information given by me is true and correct to the best of my knowledge. Date - Place - Signature Prateek Sharma
Timeline
Analyst
Conduent Business India LLP
12.2021 - Current
Process Associate
Genpact India Pvt Ltd
11.2019 - 12.2021
Claim Associate
Optum Global Solutions
10.2018 - 06.2019
Sr Executive
EXL Services
07.2015 - 09.2018
Master of Arts - Economics
MJP Rohilkhand University
Bachelor of Arts - Economics
MJP Rohilkhand University
Intermediate Certificate - Math
UP Board
High School Diploma -
UP Board