Reshma Baskaran
Senior Claims Reviewer
Chennai
Summary
Professional with strong background in claims evaluation and analysis. Adept at conducting thorough reviews, ensuring compliance with policies, and providing clear, concise recommendations. Strong collaborator focused on team success and adaptable to changing needs. Skilled in conflict resolution, data interpretation, and maintaining high standards of accuracy and efficiency.
Overview
6
6
years of professional experience
2
2
Languages
Work History
Senior Claims Reviewer
TCS
12.2021 - Current
- Collaborated closely with underwriting teams to ensure accurate evaluation of policy coverage for submitted claims.
- Expedited claim settlements by negotiating effectively with involved parties, reaching mutually agreeable outcomes.
- Enhanced claim processing efficiency by thoroughly reviewing and analyzing documentation for accuracy and completeness.
- Ensured timely resolution of claims by prioritizing workload and meeting strict deadlines.
- Assisted colleagues in complex cases, leveraging expertise in specific areas of insurance coverage to provide valuable insight.
- Boosted team morale by fostering a collaborative work environment, sharing knowledge, and offering guidance as needed.
- Maintained compliance with industry regulations and company policies through diligent review of all claim submissions.
- Increased productivity through effective management of high-volume caseloads, ensuring prompt attention to each claim.
- Reduced backlog of pending claims through efficient organization and focused attention on priority cases.
- Proactively identified opportunities for process improvements within the department, presenting recommendations to management for consideration.
- Supported continuous improvement initiatives within the department by participating in regular training sessions and workshops.
- Improved customer satisfaction rates by providing clear explanations of claim decisions and offering support during the process.
- Developed strong rapport with clients through empathetic listening skills and genuine concern for their individual situations during difficult times.
- Identified trends in claim submissions through data analysis, helping improve processes for future cases.
- Streamlined claims workflow by implementing standardized procedures and best practices for the review team.
Claims Processor Associate
TCS
12.2019 - 12.2021
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reduced claim processing time for faster customer service and improved satisfaction rates.
- Identified and reported potential fraud or abuse related to claims to protect system's integrity.
- Identified fraudulent claims through thorough investigation and documentation of findings.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Managed workload and priorities to meet claims processing meet deadlines.
Education
Bachelor of Arts - Commerce & Accounts
Sastra Deemed To Be University
Kumbakonam, India 04.2001 -
Skills
Payment Reconciliation
Financial Reporting Tools
Data Validation & Analysis
Quality assurance practices
Claims processing
Claims analysis expertise
Microsoft Office Suite
Medical coding
Coverage analysis
Claims investigation
Customer service and support
Multitasking Abilities
Strengths
- Quick Learner
- Responsible and Dedicated
- Positive Attitude
- Good Team Player
- Reliable under Pressure
Timeline
Senior Claims Reviewer
TCS
12.2021 - Current
Claims Processor Associate
TCS
12.2019 - 12.2021
Bachelor of Arts - Commerce & Accounts
Sastra Deemed To Be University
04.2001 -