Roshan Verma

• Processing fund transfers through UAEFTS, UAEIPP, DDS, ICCS and SWIFT for retail customers.
• Handling cross-border remittances with correspondent banks, ensuring timely and accurate settlements.
• Monitoring inward and outward transactions for compliance with CBUAE regulations.
• Managing FD (Fixed Deposit) booking, renewal, and liquidation as per customer instructions.
• Processing amount block and unblock requests for loans, credit cards, or regulatory requirements.
• Handling lien marking for security against loans and credit facilities.
• Processing reversal of charges/fees in cases of wrong debit, failed transactions, or customer disputes.
• Coordinating with reconciliation and product teams to resolve duplicate or incorrect debits/credits.
• Performing end-of-day (EOD) reconciliations with CBUAE and clearing systems.
• Ensuring accurate settlements across domestic and international payment channels.
• Reviewing pending items, reversals, and exception reports daily.
  Resolving failed payments, FD-related requests, reversals, and blocked fund issues.
• Ensuring customer-centric service delivery with minimal turnaround time.

Cetera Financial Group – Brokerage and Financial Process

• Managed new account openings and updated existing client records, including address changes.
• Handled addition & deletion of beneficiary details and cheque & card features on client accounts as per client requests.
• Indexed and organized client documents ensuring easy retrieval and compliance with internal policies.
• Allocated work efficiently and conducted quality checks to ensure error-free processing.
• Prepared daily incoming/outgoing volume reports to monitor operational workload.
• Generated daily and weekly SLA MIS reports to track team performance against service level agreements.
• Maintained monthly capacity MIS reports to provide insights into team productivity and resource planning.
• Conducted monthly Process Knowledge Tests to enhance team skills and maintain compliance.
• Responded to client emails and queries promptly, ensuring professional communication.
• Participated in weekly client calls with FLMs to discuss process updates, issues, and feedback.
• Developed and maintained SOPs to document and standardize process workflows.

Aetna US Healthcare claims Process

• Claims Validation: Review and determine the validity of healthcare claims submitted by members or providers to ensure accuracy and compliance with Aetna and payer guidelines.
• Coverage Determination: Verify whether billed services, treatments, and procedures are covered under the member’s healthcare plan or policy.
• Information Gathering: Coordinate with members and providers to obtain additional details or missing documentation required for claims adjudication.
• Medical & Fraud Investigation: Collaborate with medical review teams and the Special Investigation Unit (SIU) to resolve suspicious, high-value, or complex cases.
• Clinical Review: Evaluate prescribed medicines, treatments, and services against the diagnosis codes (ICD-10) and medical summaries to ensure medical necessity and policy compliance.
• Policy & Regulatory Compliance: Ensure all claims processing activities adhere to HIPAA, CMS, and payer-specific guidelines while maintaining strict confidentiality of PHI.
• System Processing: Enter, update, and adjudicate claims in payer systems, applying correct coding standards (CPT, HCPCS, ICD-10).
• Error Resolution: Identify and correct billing errors, duplicate claims, or mismatched codes through reconciliation and provider/member follow-ups.
• MOFA Claims Handling: Manage claims requiring Ministry of Foreign Affairs (MOFA) validation, coordinating with external agencies, attestation authorities, and compliance teams for approval of internationally raised claims.

Digicall Teleservices Private Ltd – Telecaller (Inbound Calls)

• Handle inbound calls from clients/customers, providing timely and accurate information on products, services, or account inquiries.
• Respond to customer queries, resolve complaints, and provide appropriate solutions or escalate issues to relevant teams.
• Record and update customer details and call interactions accurately in the CRM/system for future reference.
• Assist in lead generation, customer onboarding, or service activation as per client requirements.
• Maintain high levels of customer satisfaction by delivering professional and courteous service.
• Follow scripts, policies, and procedures to ensure consistency and compliance during calls.
• Monitor and meet daily/weekly performance metrics such as call handling time, resolution rate, and customer feedback.
• Coordinate with internal teams to provide follow-up support for pending issues or specialized requests.
• Participate in team meetings and training sessions to improve product knowledge and communication skills.