Years of professional experience in Medical CLaims , Approvals .
Priyanka Chauhan
Jaipur
Summary
Dynamic and results-driven professional with nearly 8+ years of experience in insurance claims operations. Extensive expertise in health insurance claims operations, including quality assurance, medical trainings, fraud management, and team management. Proven track record of developing and maintaining strong relationships with customers, including hospitals and policy holders. Skilled in streamlining operations to drive organizational growth and fostering a positive organizational culture through effective leadership.
Overview
8
8
Work History
Senior AR Caller
Synergy Health 360
08.2024 - Current
- Work with patients to develop self-pay arrangements and payment plans
- Enter charges accurately and expeditiously to ensure proper records handling and fast payment responses
- Process and follow up on payer denials, consulting with the patient and/or his or her family as needed
- Research and resolve client billing problems or issues
- Document payment records and issues as they occur
- Negotiated favorable payment terms with clients experiencing financial difficulties, minimizing revenue loss while maintaining positive client relations.
- Exceeded monthly collection targets consistently by maintaining a strong understanding of each client''s specific financial situation and tailoring strategies accordingly.
- Provided exceptional customer service during all interactions, resulting in an increase in overall client satisfaction ratings.
- Maintained detailed records of all communications with clients and insurance carriers, ensuring accurate tracking of account progress toward resolution.
- Responded to customer inquiries and provided detailed account information.
- Entered client details and notes into system for interdepartmental access and review.
Claims Processor: Medical claims
Mednet Bahrain (Munich Re associated Company)
06.2015 - 06.2016
- Responsible for processing all types of Medical claims (OP and IP) for Oman based Insurance companies and Providers thorough Medical audit and Data entry
- Handling self-auditing and processing claims with assigned target and quality scores
- Reporting of claims MIS on day-to-day basis
- Reporting of fraudulent claims and information encountered during claims processing and auditing
Medical approvals department (Part time)
Takaful Bahrain
07.2012 - 01.2013
- Responsible for Handling Medical calls for approvals and executing them based on insurance guidelines
- Providing complete assistance to customers on phone calls about their queries related to coverage and eligibility
- Reporting of daily calls data and escalations to Immediate supervisor
- Assisting other staff (New staff) in approvals and approval related trainings
- Responsible for training to other staff in approvals and case handling
Part time Medical Claims Executive
B.N.I-Bahrain
10.2011 - 01.2012
- Responsible for handling Direct Billing as well as Reimbursement cases from Different Providers (Hospitals, Clinics, Pharmacies, Polyclinics etc)
- Data entry for all claims within the software as per set guidelines and policy terms and conditions
- Claims assessment as per TAT with 98-100% quality scores
- Investigation of Claims which fall under Policy exclusions and Outside of policy guidelines and report to concern department for further processing
- Assisting Management in further process improvements related to insurance process and system enhancements
Sr. Process Associate, BFSI Domain
GENPACT Jaipur- India
08.2007 - 05.2011
- Processing International claims of more than 130 countries (Saudi Arabia, Bahrain, Qatar, Greece, China, UAE, France, Germany, Switzerland, UK, Denmark etc)
- Expert in handling claims related to Personal, Corporate Policies and different Providers (Hospitals)
- Assessment of Referral claims in TAT with 98-100% quality scores
- Excellent knowledge in medical Terminology, human systems, anatomical structures and their functions
- Hands on experience in handling ICD 9, ICD 10, and ICD 11 codes
- Retrieve claim data via document retrieval systems
- (iDRS)
- Understand and interpret explanations of benefits (EOB) data from variety of carriers in a variety of formats
- Accurately interpret and document, in an Access database, primary carrier name, plan type and allowed amounts from EOB’s
- Identify, document and articulate to internal customers (Claims Analysts) trends and recurring issues related to competitor reimbursement and repriced claim data
- Retrieve and interpret claim reports to assist with efficient and accurate documentation of claims for delivery to internal and external customers
- Other duties as deemed appropriate to provide a quality, timely product for delivery to our customer
Customer Care Executive
Vodafone Telecom-Jaipur-India
05.2006 - 05.2007
- Worked with Vodafone as a Customer care executive with following responsibilities:
- Handling Calls from Corporate Customers and taking care of provisioning like changing of billing plans, VAS activations etc
- Responsible for maintain MIS reports, Complaint’s registrations
- Maintaining coordination from various departments like Activations of new services and Technologies etc
- Responsible for maintaining 100% SLA
Education
B.Sc. - Biology
Rajasthan University
01.2006
Skills
- MS Excel
- Time Management Skills
- E-Mail Writing Skills
- Conference Call Essentials
- Data entry proficiency
- Medical terminology knowledge
- Healthcare Industry Experience
- Customer Service
- Multitasking
Others
- Interpersonal Skills for success
- Time Management Skills
- E-Mail Writing Skills
- Enhancing Team Fitness
- Conference Call Essentials
- Goal Setting
- Step 2 Personal Mastery
Trainingscompleted
Lean Ace Certified from Genpact India
Personal Information
- Father's Name: Sh. Ashok Chauhan
- Mother's Name: Smt. Sadhana Chauhan
- Date of Birth: 08/16/85
- Marital Status: Married
Honorsawardsaffiliations
- Best Trainee within Insurance process, 08/01/07
- Bronze award winner for best quality and production
- U Champ Award for best production in Insurance process, 2010
- Successfully completed National Cadet Corps (NCC) “C” certificate
Languages
English
Bilingual or Proficient (C2)
Hindi
Advanced (C1)
Timeline
Senior AR Caller
Synergy Health 360
08.2024 - Current
Claims Processor: Medical claims
Mednet Bahrain (Munich Re associated Company)
06.2015 - 06.2016
Medical approvals department (Part time)
Takaful Bahrain
07.2012 - 01.2013
Part time Medical Claims Executive
B.N.I-Bahrain
10.2011 - 01.2012
Sr. Process Associate, BFSI Domain
GENPACT Jaipur- India
08.2007 - 05.2011
Customer Care Executive
Vodafone Telecom-Jaipur-India
05.2006 - 05.2007
B.Sc. - Biology
Rajasthan University
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