SHREYA AGARWAL
Nainital
Summary
Results-driven Senior Claims Analyst with 8 years of experience in claims processing and healthcare revenue cycle management. Expertise includes claims analysis, documentation review, compliance, and KPI tracking. Proficient in leveraging Availity, CMS, Athena, ModMed, and UroChart for optimized payer operation.
Overview
1
1
Certification
18
18
years of professional experience
Work History
Senior Claims Analyst
GREENWAY HEALTH INDIA PVT LTD
Bangalore
04.2022 - 09.2026
- Monitored and managed RCM KPIs, analyzed performance trends, and identified process improvement opportunities to enhance operational efficiency.
- Provided actionable insights on claims data trends to inform and support strategic business decisions.
- Performed internal audit activities for 2 years, reviewing claims and operational processes for accuracy, compliance, and adherence to established guidelines.
- Analyzed claim submissions for accuracy and compliance with company policies.
- Demonstrated strong working knowledge of Availity, CMS portal, and other payer portals for claims research, eligibility, status checks, and payer-related activities.
- Worked extensively on healthcare platforms including Athena, ModMed, and UroChart.
- Mentored junior analysts in claims processing best practices, fostering their development and enhancing team capabilities.
- Developed training materials to enhance knowledge of claims management systems.
- Maintained accurate records of claims activities for audit purposes and participated in training sessions to strengthen knowledge of insurance products.
Senior Claim Analyst
MD Everywhere Pvt. Ltd.
08.2019 - 10.2021
- Evaluated customer claims to determine policy coverage and compliance with applicable laws.
- Assessed documentation for completeness, enabling accurate claims decision-making.
- Coordinated with cross-functional teams to resolve claim disputes and address customer inquiries.
Claim Analyst
Evalue Pvt. Ltd.
08.2018 - 07.2019
- Analyzed claims data to uncover trends and discrepancies, enhancing accuracy of submissions.
- Reviewed insurance policies to determine coverage details for claim evaluations.
- Collaborated with clients to collect essential documentation, streamlining claims processing.
- Analyzed accounts receivable data to pinpoint causes of underpayment and reduce prolonged days in accounts receivable.
Education Counsellor
Elgon Research Pvt. Ltd.
04.2018 - 07.2018
- Guided students in creating personalized career plans to align with aspirations and enhance future opportunities.
- Supported students through college application process, developing individual education plans to meet academic and personal objectives.
- Conducted counseling sessions for students at Elgon Research Pvt. Ltd.
- Assessed student needs through interviews, observations, and case notes.
- Coordinated with teachers and parents on behavior and academic concerns.
Business Development Manager & Trainer
VESTIGE MARKETING PVT. LTD.
01.2014 - 03.2018
- Led office support team through hiring, training, and oversight to enhance operational effectiveness.
- Organized workshops and presentation sessions to promote knowledge sharing and professional development.
- Facilitated team-building initiatives while maintaining documentation, records, and expense information for operational transparency.
Articleship
CA. Shrikumar & Associates
03.2009 - 09.2012
- Prepared monthly financial reports and reconciliations, ensuring accuracy and timeliness.
- Collaborated with team members to streamline accounting procedures, enhancing overall workflow efficiency.
- Executed day-to-day accounting duties with precision, supporting overall financial accuracy.
Education
CA. IPCC -
ICAI
New Delhi01-2014
M.Com -
MJP RU University
Bareilly01-2011
B.Com -
MJP RU University
Bareilly01-2009
Intermediate -
CBSE
New Delhi01-2006
High School -
U.P. Board
New Delhi01-2004
Skills
- Claims Analysis & Adjudication
- Claims Trend Analysis
- Claims Documentation
- RCM KPI Monitoring
- Healthcare Revenue Cycle
- Payer Portal Management
- Internal Audit
- Risk Assessment
- Process Improvement
- Cross-Functional Collaboration
- Mentorship and training
- Office suite proficiency
Certification
Multiple recognitions for agility, service, accountability, and respect.
LANGUAGES
Hindi — Advanced (C1), English — Advanced (C1)
Timeline
Senior Claims Analyst
GREENWAY HEALTH INDIA PVT LTD
04.2022 - 09.2026
Senior Claim Analyst
MD Everywhere Pvt. Ltd.
08.2019 - 10.2021
Claim Analyst
Evalue Pvt. Ltd.
08.2018 - 07.2019
Education Counsellor
Elgon Research Pvt. Ltd.
04.2018 - 07.2018
Business Development Manager & Trainer
VESTIGE MARKETING PVT. LTD.
01.2014 - 03.2018
Articleship
CA. Shrikumar & Associates
03.2009 - 09.2012
CA. IPCC -
ICAI
M.Com -
MJP RU University
B.Com -
MJP RU University
Intermediate -
CBSE
High School -
U.P. Board