TAJINDER SINGH MATHARU
New Delhi
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
8
8
years of professional experience
Work History
Appeals Analyst
Optum Global Advantage Pvt Ltd.
Gurgaon
03.2019 - Current
- Working on Employer and Individual (ie, Commercial Insurance) post-service and claim appeals case processing, for provider, resolve all the issue via Escalation tracking tool
- Research and working on denials in accordance with company policies and procedures, CMS guidelines
- Providing 100% end to end research within the TAT
- Working on multiple interfaces (Escalation Tracking system (ETS), UNET, Microsoft Office applications etc.) simultaneously to collate & research data and complete allocated processing
- Working on Client letter to provide the claim research in written e.g
- Applicable policy, Applicable Reimbursement policy, Medical Logics and etc
- Initiate claim adjustments on individual cases when necessary and follow and track until completion
- Providing operational support by auditing internal cases of new hires to ensure the business quality is met.
Claims Examiner
Calibrated Healthcare Systems India Pvt Ltd.
Gurgaon
08.2015 - 01.2019
- Evaluates and Processes claims in accordance with company policies and procedures, CMS guidelines
- Knowledge of Commercial, Medical/Medicaid and Medicare claims processing guidelines
- Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication
- Understand Provider contracts
- Thorough knowledge of HIPAA.
Education
Skills
- Able to work as a contributing and supportive team member
- A commitment to always provide quality service
- Quick learner and Good interpersonal skills
- Team player/team lead attitude and also works well independently
- Proficient in Microsoft Office Suite applications
Languages
Punjabi
First Language
Hindi
Proficient (C2)
C2
English
Upper Intermediate (B2)
B2
Timeline
Appeals Analyst
Optum Global Advantage Pvt Ltd.
03.2019 - Current
Claims Examiner
Calibrated Healthcare Systems India Pvt Ltd.
08.2015 - 01.2019
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