Sai Raj Nikhil Aiely

Senior Claims Associate

Carelon Global Solutions

08.2021 - Current

Ensured high accuracy in managing large threshold stop-loss claims to minimize penalties.
Coordinated multi-disciplinary meetings to discuss complex cases involving multiple stakeholders, fostering collaboration towards an optimal outcome.
Collaborated with team members for successful resolution of complex claims, ensuring accurate payouts to policyholders.
Managed high-priority claims in a time-sensitive manner, resulting in expedited resolution and satisfied clients.
Exceeded department goals consistently by maintaining a high level of productivity and accuracy in processing claims.
Reduced claim-processing errors through thorough investigation and effective communication with all parties involved.
Presented findings from periodic audits to management, offering recommendations for improvement that led to greater efficiency within the department.
Negotiated fair settlements with legal counsel or other third-party stakeholders on behalf of the company during dispute resolutions.
Provided mentorship and guidance to junior team members, helping them develop their skills and progress in their careers.
Analyzed trends within assigned portfolio to proactively address common issues and improve overall team performance.
Handled escalated customer concerns professionally while finding mutually beneficial solutions for both parties involved.
Trained new Claims Associates on company policies and procedures, contributing to their rapid integration into the team.
Handled adjustments, ensuring alignment with cost-sharing agreements.
Processed claims for jointly administered accounts to reconcile cost shares.

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