Shraddha Patil
Pune
Overview
1
1
Certificate
7
7
years of professional experience
Education
MBA - Human Resources Management
CDG Institute of Management
Pune07.2019
Master of Science - Microbiology
Fergusson College
Pune07.2017
Bachelor of Science - Microbiology
Gokhale Edcuation Societys R.Y.K.Science
Nashik07.2015
Higher Secondary Education (HSC) -
HPT ARTS AND RYK SCIENCE COLLEGE
Nashik 07.2012
Secondary School Certification (SSC) -
H.R . Patel High School
Nashik 07.2010
Skills
- Claims investigation and research
- Claims reports and documentation
- Medical terms and procedure knowledge
- Insurance claims processing
- End to end Understanding of insurance business
- Knowledge of disability insurance,
- Hospital indemnity, cancer, accident incurance claims
- Worked on CMS , Fineos application for managing claims, PEGA, CPS, Claim central for appeals management
- Worked on ICD 10 codes , CPT codes, UB0 forms, EObs
- Medical Summarization, Medical Scribe
- Worked on Next Gen, Claim Central, DCF
Certification
Maharashtra State Certificate in Information Technology
Timeline
Operations Analyst (Medical Summarization)
Allstate
07.2022 - Current
Claims Appeals and Grievances Process Lead
CHCS Services, INC.
01.2022 - 06.2022
Claims Process Analyst
Principal global services
10.2018 - 10.2021
Clinical Document Specialist Safety -I
TransPerfect Legal Solutions, Ind . PVT LTD
07.2017 - 09.2018
MBA - Human Resources Management
CDG Institute of Management
Master of Science - Microbiology
Fergusson College
Bachelor of Science - Microbiology
Gokhale Edcuation Societys R.Y.K.Science
Higher Secondary Education (HSC) -
HPT ARTS AND RYK SCIENCE COLLEGE
Secondary School Certification (SSC) -
H.R . Patel High School
Summary
Skilled in claims investigation and adept at medical summarization, significantly enhanced operations efficiency at Allstate. Expertise in Medical field and proactive problem-solving skills led to improved claims processing accuracy. Known for dedication and ability to mentor new hires, Excel in fast-paced environments, consistently meeting tight deadlines.
Experienced insurance Claims process lead with over 7+ years of
experience in Life and Health insurance domain. Excellent reputation for
resolving problems and improving customer satisfaction. Effective
Medical Claims Process lead with strong Medical field background.
Expertise in adjudication and appeals processing. Driven performer
equipped to handle multiple tasks effectively. Exemplary worker with
highly investigative skills when processing claims.
Work History
Operations Analyst (Medical Summarization)
Allstate
07.2022 - Current
- Review and summarize medical information such as Attending Physician Statements, lab reports, paramedic exams, and/or other related underwriting information consistent with specifications.
- To review the medical records of the claimant and provide precise summaries covering all relevant medical facts required for claim adjudication
- Provide medical decisions/recommendations on the severity of the medical condition and its treatment is preferred.
- Detect, Interpret and update treatment-related information from cases of patients which enables to convert of physical health information into Electronic Medical Records (EMR) or Electronic Health Record (EHR)
- Prepared maintenance and compliance reports for executive summaries and presentations.
- Creating Training Modules for new joiners
- Part of quality auditing team.
- Designed plans to improve operations and suggested changes to systems for the overall organization.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Performed duties in accordance with applicable standards, policies, and regulatory guidelines to promote a safe working environment.
- Proved successful working within tight deadlines and a fast-paced atmosphere.
- Identified issues, analyzed information, and provided solutions to problems.
Claims Appeals and Grievances Process Lead
CHCS Services, INC.
01.2022 - 06.2022
- Prepared variety of different written communications, reports and documents.
- Experience in filing appeals for Hospital indemnity, Cancer, Accident policy for first and second level appeals.
- Experience in adjudication of claims.
- Strong understanding of medical terminology, diagnosis codes, denial codes, ICD 9-10 Codes, and calculating Interest and Penalties, UB’s, 1500’s, Remittance Advice, EOB’s.
- Used Claim management system (CMS), PEGA, CPS tools to program, set up functions, and enter data for claims and appeals.
- Used Microsoft Word Microsoft Excel and other software tools to create documents and other communications.
- Verified insurance claims and determined fair amount for settlement.
- Performed data entry operations to update database with customer responses.
- Performed quality checks on transactions.
- Improved operations through consistent hard work and dedication.
- Collaborated with team members to achieve target results.
- Carried out day-to-day duties accurately and efficiently.
- Worked flexible hours across night, weekend and holiday shifts.
Claims Process Analyst
Principal global services
10.2018 - 10.2021
- Research and process claims according to processing guidelines and benefit.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Acted as claims subject matter expert, answering internal and external questions and inquiries.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Contributed in collection of functional inputs for simplification of claims process through RPA development.
- Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork.
- Carried out day-day-day duties accurately and efficiently.
- Managed large volume of medical claims on daily basis.
- Maintained confidentiality of patient finances, records and health statuses.
- Processed claims adjustments when applicable.
- Assists with training of new hires.
- Knowledge and use of ICD-9, ICD-10 and CPT coding.
- Worked flexible hours; night, weekend, and holiday shifts.
Clinical Document Specialist Safety -I
TransPerfect Legal Solutions, Ind . PVT LTD
07.2017 - 09.2018
- Processing and evaluation of Adverse Events / SAE/ Post Marketing Adverse Events to ensure accurate and consistent data entry and processing from source documents, with emphasis on timeliness and quality.
- Ensure accurate and consistent coding of medical history, drugs and adverse event terms.
- Assess adverse event reports for seriousness, causality and expectedness as per applicable labeling, consulting Medical Safety Expert whenever needed.
- Conduct and analyze, medical and scientific literature searches using critical judgment and professional / scientific expertise to support projects or queries.
- Generate concise, accurate and well-written case narratives
- Support generation of Annual Safety Updates, Periodic Safety Reports, and other cumulative safety reports including data retrieval, analyses and quality control.
- Contribute towards preparation of standard operating procedures, process related documents and product guidance documents.
- Reconciles SAEs in accordance with project specific guidelines.
- Attend various meetings; contributes to presentation of safety process at various meetings.
- Mentor and train new hires or other associates
- Participate in audits or inspections.
- Maintained excellent attendance record, consistently arriving to work on time
Additional Information
Participated as Student volunteer in Thalesemia and Anemia workshop at university
publication
Herbicidal activity of Parthenium hysterophorus (ISBN 978-81-920431-3-5) publication date -12/19/2016
Parthenium extract contains allechemicals has shown suppression of plant growth and marginal burning of leave because of systemic action from the tests and observation it concludes that parthenium in an effective herbicide
Maharashtra State Certificate in Information Technology
Scored 96% in MSCIT
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