RESHMA R
Bangalore
Summary
Experienced in processing claims in high-volume environments. Successful at managing complete claims process with minimal direction. . Proficient claims associate skilled in handling high volumes of claims. Processes adjustments based on identifiable liability and compensability. Supports work of senior team members by organizing documentation and assisting on complex cases.
Overview
8
8
years of professional experience
Work History
Claims Associate
Carelon Health Global Solutions
Bangalore
12.2020 - 03.2025
- Reviewing, researching, investigating, and adjusting the health insurance claims.
- Understanding multiple products and different levels of benefits.
- Responsible for handling incoming medical claims.
- Applying benefits according to specific workflows and procedures.
- Managed health insurance claims with precision, ensuring accuracy, and compliance.
- Utilized MS Office tools for data analysis, reporting, and documentation.
- Committed to delivering meticulous and accurate work in the dynamic field of healthcare administration.
- Quality Assurance and Compliance ensured adherence to regulatory guidelines and internal policies, maintaining a high standard of accuracy and compliance in health insurance claims processing.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Processed claims accurately and efficiently within established timelines.
- Assisted in training new associates on claims processing procedures and systems.
- Reviewed medical records and documents submitted by claimants to ensure accuracy and completeness of information provided.
AR Associate
Omega Healthcare Management Service
Bangalore
10.2018 - 01.2020
- Perform pre-call analysis and check status by calling the payer or using IVR or web portal services
- Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference
- Record after- call actions and perform post call analysis for the claim follow-up
- Assess and resolve enquires, requests and complaints through calling to ensure that customer enquires are resolved at first point of contact
- Provide accurate product/service information to customer, research available documentation including authorization, nursing notes, medical documentation on Client's systems, interpret explanation of benefits received etc prior to making the call
- Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments
- And also working on Denial Claims send required Documents like Medical Records, W9Form, Appeal, Claim Form, Primary EOB
- Reviewed and reconciled discrepancies in patient billing and insurance claims.
- Developed relationships with clients to enhance communication regarding payment status.
- Analyzed current processes related to Accounts Receivable and recommended improvements where necessary.
CLEINT RELATIONSHIP OFFICER
EXPERT CALLERS
BENGALURU (BANGALORE) URBAN
09.2017 - 10.2018
- Resolved escalated customer issues in a professional manner.
- Managed multiple accounts simultaneously while providing superior service quality.
- Maintained accurate records of customer interactions, inquiries, complaints, sales.
- Monitored client feedback and generated reports on customer satisfaction levels.
- Prepared reports on customer feedback trends for management review.
- Participated in team meetings discussing current projects, initiatives.
- Prepared monthly performance reviews of client accounts under my responsibility.
- Monitored customer health scores and initiated proactive measures to address potential churn risks.
- Developed and implemented loyalty programs to reward and retain top customers.
- Addressed customer questions and concerns regarding products and services.
- Increased profitability and revenue by identifying customer needs and determining appropriate offerings.
Education
MBA - MASTER OF BUSINESS ADMINISTRATION
ST JOSEPH EVENING COLLEGE
BANGALORE08-2021
SSLC -
St. Mariam English High School
2nd PUC -
Siddhartha Pre University College
B.com -
Hasanath Degree College for women
Skills
- Good communication skills
- Ready to take responsibilities
- Quick learner with good interpersonal skills
- Microsoft Office, Excel, MS Word
- Problem solving
- Healthcare business operations
- Citrix
- Jira Application
- MS Office Outlook Word, Excel PPT
- PC Plan configuration
<Enter your own>
- Father's Name: RAFIQ AHMED
- Age / Date of birth: 10/01/1995
- Gender: Female
- Nationality: Indian
- Marital status: Married
- Religion: Muslim
Disclaimer
I hereby declare that the above information is correct and true to the best of my knowledge and belief.
Languages
6,C2,5,C1,6,C2,6,C2
Timeline
Claims Associate
Carelon Health Global Solutions
12.2020 - 03.2025
AR Associate
Omega Healthcare Management Service
10.2018 - 01.2020
CLEINT RELATIONSHIP OFFICER
EXPERT CALLERS
09.2017 - 10.2018
MBA - MASTER OF BUSINESS ADMINISTRATION
ST JOSEPH EVENING COLLEGE
SSLC -
St. Mariam English High School
2nd PUC -
Siddhartha Pre University College
B.com -
Hasanath Degree College for women
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