Sumit Kumar
Gurugram
Summary
Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
4
4
years of professional experience
Work History
Healthcare Claims Processor
TRPC SERVICE TEAM PVT. LTD.
Gurgaon
05.2022 - Current
- 401(k) Plans
- Communicated with clients to gather necessary documentation for claim processing.
- Collaborated with team members to resolve complex claim issues efficiently.
- Evaluated claim information to determine eligibility and coverage under policies.
- Utilized company software to track claim status and manage workflows effectively.
- Ensured timely responses to client inquiries regarding claim statuses and outcomes.
- Verified claim data correctness in preparation for processing.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
- Provided technical guidance and training to new staff members regarding claim processing procedures.
- Validate Member, Provider and other claims information by manually.
- Determine Accurate payment
- Maintain productivity goals, quality standards again timeframes.
- Processed and reviewed claims for accuracy and compliance with company policies.
- Trade Back, Monthly premium recurring and Trust Distribution processed in Healthcare.
Education
B.Tech - Computer Science
Kurukshetra University
01.2017
Higher Secondary - Science
Bihar Board
01.2013
Senior Secondary -
Bihar Board
01.2011
Skills
- Claim Processing
- Claims Handling
- Hard working
- Inducing of claims documents
- Documentation verification
- Workflow management
- Claims processing software
- Claims review
- Premiums calculation
- Paperwork processing
- Teamwork
- Decision-making
- Problem-solving abilities
- Insurance coverage limits
Hobbies and Interests
- Exploring Internet
- Play Cricket
Personal Information
- Date of Birth: 09/25/95
- Gender: Male
Languages
English
Intermediate (B1)
B1
Hindi
Intermediate (B1)
B1
Timeline
Healthcare Claims Processor
TRPC SERVICE TEAM PVT. LTD.
05.2022 - Current
B.Tech - Computer Science
Kurukshetra University
Higher Secondary - Science
Bihar Board
Senior Secondary -
Bihar Board