Supriya Goriwale

Claims

• Process and re-adjudicate healthcare claims in compliance with organizational guidelines and regulatory standards.
• Review and verify medical billing documents to ensure accuracy and completeness before claim settlement.
• Coordinate disbursement of claim payments, including managing checks, stop payments, and cancellations.
• Interpret and resolve complex claim scenarios efficiently, ensuring timely and accurate outcomes.
• Verify patient eligibility, insurance plan details, and demographic data using internal software tools.
• Identify and correct claim discrepancies by analyzing billing edits and applying appropriate solutions.
• Provide cross-functional support to the team and assist in maintaining workflow continuity.

PDM

• Manage provider data for U.S. health plans, including enrollment, credentialing, and termination (ADD/UPDATE/TERM transactions).
• Utilize multiple systems such as QNXT, EZAP, P360, NPPES, CAQH, and CMS.gov for accurate provider data entry and validation.
• Review contracts, fee schedules, and credentialing documents to ensure compliance with industry standards and accreditation bodies.
• Maintain up-to-date knowledge of healthcare regulations, credentialing requirements, and medical terminology.
• Resolve disputes and discrepancies between payers and providers, particularly regarding preauthorization issues.

• Interpret and respond to client requirements on the car parts portal, delivering tailored solutions specific to the South and North New Zealand regions.
• Collaborate with estimation and production teams to ensure seamless coordination during both pre-sales planning and post-sales execution.
• Perform monthly analysis of sales, profit/loss, and third-party inventory procurement to support strategic decision-making.
• Track and evaluate customer orders and part availability to ensure timely fulfillment and high service quality.
• Identify trends and insights from regional demand data to enhance forecasting and optimize inventory sourcing strategies.

Total Loss

• Adjudicated coverage determinations and settlements up to designated authority level under supervision.
• Analyzed vehicle damages and assessed total loss claims in compliance with company policies.
• Provided clear, empathetic communication to policyholders regarding total loss processes.
• Utilized industry-standard tools to determine fair market value for total loss vehicles.
• Maintained accurate records and prepared detailed reports to ensure legal compliance.
• Coordinated with underwriters, appraisers, and legal teams to resolve complex claims.
• Evaluated and authorized claims payments within designated limits, ensuring accuracy.
• Approved settlement amounts for total loss claims after validating vehicle valuation.

• Coordinate seamlessly between internal teams, banks, and clients to ensure smooth execution of financial agreements and timely documentation.
• Ensure real-time updating and accuracy of customer information to support sales strategies and enhance business intelligence.
• Collaborate with the marketing team to design and implement effective lead nurturing and conversion strategies.
• Manage end-to-end logistics for marketing events, ensuring brand visibility and maximizing customer engagement.
• Deliver personalized customer experiences through in-depth consultations, ensuring alignment with client needs and driving successful sales closures.