Raj Kumar Gulla
hyderabad
Summary
• Skilled Appeals Representative with significant experience in healthcare claims and appeals processing. Possess strong knowledge of regulatory standards, policy interpretation, and claim dispute resolution. Known for exceptional problem-solving capabilities, negotiation skills, and ability to achieve beneficial outcomes. Previous roles involved demonstrating consistent efficiency in handling high-volume caseloads while maintaining quality standards.
• Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
2
2
years of professional experience
Work History
Appeals Representative
Optum
Hyderabad
09.2023 - Current
- Reviewed and processed appeals for medical claims efficiently.
- Communicated with providers to gather necessary documentation for appeals.
- Analyzed policy guidelines to determine appeal eligibility and outcomes.
- Conducted research on complex cases to ensure accurate resolution of appeals and grievances.
- Monitored incoming correspondence from providers to ensure timely response to inquiries.
- Assessed appeals and grievances to determine eligibility for reconsideration or review.
- Identified areas of improvement in the appeals process and developed strategies to enhance efficiency.
Education
B. Com - computer applications
VIVEKANAND DEGREE COLLEGE ( OSMANIA UNIVERSITY)
04.2001 -
ssc
SRI SAI HIGH SCHOOL
Hyderabad 04.2001 -
CEC
MASTERS JUNIOR COLLEGE
Hyderabad , India 04.2001 -
Skills
- Claims processing
- Grievance handling
- Appeal processing
- Time management
- Attention to detail
- Claims management
- Advanced Excel
Hobbies and Interests
- Exercising and healthcare
- Playing int
- Team or individual sports
Languages
- Hindi
- Telugu
- English
Timeline
Appeals Representative
Optum
09.2023 - Current
B. Com - computer applications
VIVEKANAND DEGREE COLLEGE ( OSMANIA UNIVERSITY)
04.2001 -
ssc
SRI SAI HIGH SCHOOL
04.2001 -
CEC
MASTERS JUNIOR COLLEGE
04.2001 -