Rahul Singh
Greater Noida west
Summary
Dynamic Sr. Claims Representative with extensive experience at UNET OGA, excelling in fraud claims management and team support. Proven ability in data analysis and effective communication, achieving multiple awards for outstanding performance. Skilled in Microsoft Excel and adept at meeting deadlines while ensuring compliance and accuracy in claims processing.
Overview
10
10
years of professional experience
Work History
Sr. Claims Representative
UNET OGA
07.2023 - Current
- Handling the fraud claims and process as per ORS instruction.
- Reviewing claims for possible fraud.
- Verifying the medical records and send the instruction accordingly for further processing.
- Support team members by solving real time queries.
- Assigning and managing the inventory workflow.
- Auditing the claims internally and helping the co-workers to meet their quality parameters.
Senior Claims Associate
Prime team
01.2019 - 06.2023
- Adjusted payments and reconciled provider transactions based on claims analyst and automated system inputs.
- Resolved escalations from providers regarding claim denials and underpayments.
- Reviewed UNET system to ensure compliance with adjustment rules.
- Generated letters and documentation for providers and adjudicators.
- Processed claim adjustments following first pass review and incorporated resubmitted forms from providers.
- Managed Medicare and Medicaid claims, verifying allowable amounts and addressing overpayments and underpayments.
- Achieved multiple Star and Venus awards throughout the year for outstanding performance.
Senior Employer Installation Representative
Tops team
07.2016 - 12.2018
- Working for automation of healthcare benefits for the UHG clients and managing, correctness of benefits in system with accuracy so that the claims are paid automatically via system without having much manual interference.
- Manually testing Tops policies for front end and online SPI and notifying bugs with the help of claim testing tool.
- Validating claims on dummy systems to check if policies are built properly or not and verifying payments.
- Making changes as per new healthcare amendment in the existing accounts of customers.
- Renewing the customer policy as per their intent on each and every open enrollment window.
- Managing timely enrollment of new customers with correct benefits in UHG systems.
Claims Associate
Concentrix Daksh India PVT LTD
07.2015 - 05.2016
- Handling the inpatient and outpatient claims which needs manual adjudication.
- Worked on New Business, Renewals, Maintenance and Off Renewals.
- Also work on Member Enrollment and Member Cancelation.
- Support New Hires and reviewing his/her Policy before going to QA and provide feedback to them on daily basis.
- Handling the calls regarding queries and updates.
- Given a successful idea for implementation to meet the quality targets.
Education
Bachelor of Arts -
Avadh University
FaizabadIntermediate -
Allahabad board
Allahabad, U.PMatriculation -
Allahabad board
Allahabad, U.PSkills
- Microsoft Word and Excel
- Data analysis and visualization
- Power BI expertise
- Windows operating systems
- Bilingual proficiency
- Deadline management
- Effective communication
Personal Information
- Date of Birth: 09/10/92
- Gender: Male
- Nationality: Indian
- Marital Status: Married
Affiliations
- Part of the Sports Engagement Team, organized and managed multiple sports events to enhance employee engagement and team spirit, and execute diverse sports and recreational events, fostering a positive and collaborative workplace culture
- Appointed captain of the corporate cricket team, I successfully led the team multiple tournament victories and promoted team bonding and employee engagement through sport
Disclaimer
I hereby declare that the information provided above is true to the best of my Knowledge.
Timeline
Sr. Claims Representative
UNET OGA
07.2023 - Current
Senior Claims Associate
Prime team
01.2019 - 06.2023
Senior Employer Installation Representative
Tops team
07.2016 - 12.2018
Claims Associate
Concentrix Daksh India PVT LTD
07.2015 - 05.2016
Bachelor of Arts -
Avadh University
Intermediate -
Allahabad board
Matriculation -
Allahabad board
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