SACHIN KUMAR
GREATER NOIDA
Summary
Dynamic Claims Adjustments Associate at Optum Global Solutions, adept in Medicare and Medicaid claims processing. Demonstrated flexibility and precision in managing claims, achieving targets with high accuracy. Proficient in ICD and CPT coding, while enhancing team efficiency through collaboration and support. Committed to compliance and excellence in claims resolution.
Overview
4
4
years of professional experience
Work History
Claims Adjustments Associate
Optum Global Solutions Private Limited
03.2022 - Current
- Processed M&R Rework claims by approving or denying documentation and calculating benefit amounts.
- Coordinated with benefits department to clarify explanations of benefits (EOB).
- Managed claims using Cosmos and CPA systems, ensuring data accuracy across applications.
- Achieved targets while maintaining high accuracy in claim resolution.
- Assisted team members in processing claims to enhance overall efficiency.
- Audited processed claims to ensure compliance with company standards.
Education
Bachelor of Commerce -
Choudhry Charan Singh
Meerut 08-2022
Skills
- Flexibility and development
- Medicare and Medicaid claims
- Coordination of benefits
- Authorization processes
- Patient responsibility management
- Member and provider selection
- Manual pricing strategies
- Timely filing practices
- Adjustment procedures
- ICD and CPT coding
Languages
- English
- Hindi
Positions
Claims Adjustments Associate, Optum Global Solutions Private Limited, 03/01/22, 09/30/24, Work on M&R rework claims, Resolve claims by approving or denying documentation, calculating benefits due, and determining compensation settlements, Work on copay, co-insurance, and deductibles, Coordinate with benefits with the provided explanation of benefits (EOB), Process claims on Cosmos and CPA with different data and applications, Exceeded the targets with the best accuracy, Helped team members in processing the claims, Audit the processed claims
Work Info
SUNIL KUMAR, Claim Operations, 10356-06870INDIN523-846701, 23, 06/11/25
Timeline
Claims Adjustments Associate
Optum Global Solutions Private Limited
03.2022 - Current
Bachelor of Commerce -
Choudhry Charan Singh