RICHIKA GHAI
Gurgaon
Summary
Current job role plays a critical role in the insurance domain by ensuring accurate and competitive pricing for insurance policies, supporting underwriting decisions, maintaining regulatory compliance, and providing excellent customer service to insurance stakeholders.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Senior Process Executive
Cognizant
05.2023 - Current
- Project: Hartford (Sep, 24 to Present)
- Recouping or recovering payments that were mistakenly made or overpaid by group benefit plan (insurance or health plans).
- Systematic handling of cash flow (payments or reimbursement) and ensure that payments are made in a timely and accurate manner.
- Cash received and cash spend must be regularly reconciled to ensure that the insurer or benefits provider is financially solvent and the payment match the claim submitted.
- Refund apply in cash application received from insured in different mode of payment like Lockbox, credit card, ACH(Automated clearing house),EFT etc.
- Using Oracle based Applications: DCS (Disability claim system), DPP (Disability payment Processing),GTreasury, LP (Loss processing), Cash Pro.
- Project: EMC Insurance (Feb, 24 to Aug, 24)
- Analyze data to assess risk factors.
- Provide support to underwriters.
- Interact with insurance agents, brokers, and policyholders to provide assistance
- Perform quality assurance checks to ensure accuracy and consistency.
- Project: Plansource (May, 23 to Feb, 24)
- Responsible for implementing EDI systems within healthcare organizations and integrating them with existing open enrollment (OE) management systems.
- Processing of open enrollment (OE) transactions using EDI standards such as ANSI X12 or 834 and monitor incoming and outgoing enrollment data, validate data accuracy and completeness, and troubleshoot any errors or discrepancies.
- Map data elements between different formats and standards to ensure seamless data exchange between disparate systems.
- Before deployment, EDI specialists conduct thorough testing of open enrollment (OE) transactions to identify and resolve any issues with data integrity, formatting, or transmission.
- Provide technical support and troubleshooting assistance to resolve issues related to Open Enrollment (OE) data exchange.
- Investigate and resolve transaction errors, address connectivity issues, and assist end-users in navigating EDI systems and processes.
EDI Analyst- Benefit Eligibility Process
A3 logics
06.2021 - 05.2023
- Project Name- PlanSource, One source Many Benefits, Salt Lake City, (USA)
- Project Description- PlanSource is a third party administrator firm providing strategic benefits, HR, and risk management services expertise in the mechanics of healthcare, risk management, and employee culture.
- Actively working as an EDI (Electronic Data Interchange) Configuration Analyst on Healthcare Domain in Jaipur based IT company A3Logics Pvt Ltd. Where my responsibilities are:
- Collecting the client requirement, to summarize them and help them restructuring the raw data in a usable Secure EDI transaction in Open Enrollment (OE) for example, converting raw data into 834 file format, Custom format, .xlsx format etc
- Analysis, implementation, testing and execution of the build format files in Open Enrollment (OE)
- Tools Used- Benefit Eligibility Process (Benadmin for Plansource), Clearing House, FileZilla, MS Excel (Advanced), MSOffice
- Transactions- Hands on Experience in 834.
- EDI Tool: Clearing House, Benefit Administrative, Optum etc.
Education
M.Com - Commerce
MGSU
01.2014
B.Com - Commerce
MGSU
01.2012
Skills
- Excel
- Electronic Data Interchange
- HIPAA
- MS Office
- Open Enrollment
- Benefit Eligibility Process
Certification
Advance Excel
Languages
English, Hindi, Punjabi
Timeline
Senior Process Executive
Cognizant
05.2023 - Current
EDI Analyst- Benefit Eligibility Process
A3 logics
06.2021 - 05.2023
M.Com - Commerce
MGSU
B.Com - Commerce
MGSU
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