RAKESH K
Bangalore
Summary
Senior specialist with extensive expertise in the field, bringing several years of experience in operational management. Proven ability to build and lead high-performing teams to achieve operational excellence. Skilled in optimizing processes and enhancing team productivity.
Overview
7
7
years of professional experience
Work History
Senior Specialist Claims Examiner
Canadalife
Bengaluru
10.2022 - Current
- Conducted thorough audits of daily resolved tasks, ensuring accuracy in dental claims adjudication.
- Responded to inquiries from internal and external teams at the site level.
- Released site-level claims exceeding dollar thresholds.
- Guided the team in error reduction strategies to improve overall performance.
- Developed and presented PPTs on complex or frequently occurring scenarios.
- Organized refresher sessions based on common questions and identified knowledge gaps.
- Performed root cause analyses on team-reported errors to identify improvement areas.
- Mentored new team members by clarifying processes and answering queries.
- Published daily productivity reports to enhance operational transparency.
- Conducted feedback sessions and discussed action plans.
- Conducted internal process knowledge tests twice monthly to ensure team proficiency.
- Prioritized age claims, and provided timely status updates for site-level tasks.
- Reviewed and audited special override claims at site level, delivering thorough reports daily and monthly.
Senior Claims Processor
Hinduja Global Solution
Bengaluru
11.2018 - 09.2022
- Analyzed claims scenarios and types to ensure compliance with policy requirements.
- Verified coverage and benefits for providers and members to facilitate accurate processing.
- Processed claims accurately based on reviews of submitted documentation.
- Determined claim outcomes by paying, denying, or requesting additional information.
- Maintained turnaround times for claims in alignment with team lead expectations.
- Communicated current status of aged claims to clients and team leads regularly.
- Followed up on client requests to ensure timely resolution and appropriate actions.
- Investigated escalations from clients and provided responses within 24 hours.
Education
B.Com -
Silicon City College of Management And Commerce
Bangalore, Karnataka06-2018
PUC -
Karnataka Department of Pre University Education
Karnataka03-2015
SSLC -
Karnataka Board of Secondary Education
Karnataka01-2013
Skills
- Leadership and decision-making
- Multitasking and time management
- Public speaking and presentation
- Adaptability and flexibility
- Continuous improvement strategies
- Resource allocation expertise
Hobbies and Interests
- Listening to music
- Playing cricket
- Social service
Languages
Kannada
First Language
English
Advanced (C1)
C1
Accomplishments
- Icon of the year 2024
- Titan Award winner Q1 2024
- Top Gun for the month of May 2021
- Top Gun for the month of June 2021
Technical Skills
- Microsoft Office Suite (MS Excel, MS PowerPoint, and MS Word)
Timeline
Senior Specialist Claims Examiner
Canadalife
10.2022 - Current
Senior Claims Processor
Hinduja Global Solution
11.2018 - 09.2022
B.Com -
Silicon City College of Management And Commerce
PUC -
Karnataka Department of Pre University Education
SSLC -
Karnataka Board of Secondary Education