TONY JOSEPH RUFUS
Healthcare Operations Analyst
Trivandrum
Summary
Detail-oriented healthcare operations professional with two years of experience in U.S. Revenue Cycle Management, specializing in eligibility verification, benefits investigation, and prior authorization support. Skilled in managing client relationships and resolving operational queries while training team members to boost performance. Collaborated with commercial, Medicare, and Medicaid payers to streamline processes and enhance outcomes.
Overview
2
2
Languages
2
2
Certifications
2
2
years of professional experience
Work History
Insurance Claims Specialist L1
CareRevenue Technologies Pvt Ltd
01.2026 - Current
- Review insurance coverage, deductibles, copayments, coinsurance, and authorization requirements to support accurate claim processing.
- Conduct eligibility and benefits verification for U.S. healthcare patients across commercial, Medicare, and Medicaid insurance plans.
- Communicated with insurance representatives and provider offices to validate coverage information and resolve discrepancies effectively.
- Supported prior authorization and benefits investigation workflows, ensuring timely patient care and reimbursement.
- Maintained accurate documentation of payer responses and patient insurance information in practice management systems, enhancing data reliability.
- Utilize dental practice management software and Microsoft Office tools to manage daily operations and maintain workflow efficiency.
- Awarded the Key Resource Award in recognition of performance, reliability, and contribution to operational goals.
- Trained and mentored 13 new hires, supporting onboarding, process understanding, and quality improvement initiatives.
Junior Insurance Claims Specialist L1
CareRevenue - Good Methods Global Pvt.Ltd
06.2024 - 12.2025
- Reviewed insurance claims to verify alignment with regulatory standards and internal policies.
- Scrutinized and processed multifaceted insurance claims, elevating accuracy and cutting down processing time.
- Partnered with cross-functional teams to optimize claims processing workflows, and enhance efficiency.
- Educated new team members on claims procedures and best practices, cultivating a proficient workforce.
- Analyzed insurance claims to ensure compliance with regulatory standards and internal guidelines.
- Processed and reviewed complex insurance claims, enhancing accuracy and reducing processing time.
- Collaborated with cross-functional teams to streamline claims processing workflows and improve efficiency.
- Trained new team members on claims procedures and best practices, fostering a knowledgeable workforce.
Education
B.Com - Computer Applications
Rajagiri College of Management & Applied Sciences
Kochi01-2024
Higher Secondary Education (CBSE) - Science with Computer & Maths
MGM Central Public School
Trivandrum01-2021
Secondary Education (CBSE) - Science With Computer & Maths
MGM Central Public School
Trivandrum01-2019
Skills
Claims processing
Claims Management Software
Insurance Portals
Practice management software
Data Entry Automation
Data validation
Power BI
Data Analysis Tools
Microsoft Office
Internet Research
Certification
2024 The Complete Financial Analyst Course - Udemy
Timeline
Insurance Claims Specialist L1
CareRevenue Technologies Pvt Ltd
01.2026 - Current
Junior Insurance Claims Specialist L1
CareRevenue - Good Methods Global Pvt.Ltd
06.2024 - 12.2025
Higher Secondary Education (CBSE) - Science with Computer & Maths
MGM Central Public School
B.Com - Computer Applications
Rajagiri College of Management & Applied Sciences
Secondary Education (CBSE) - Science With Computer & Maths
MGM Central Public School
Internship Experience
- May 2023 (4 Weeks)
- NS SARMA & ASSOCIATES I TRIVANDRUM
- Accounts / Audit Intern
- Audited and Vouched cash/bank transactions of Cordial Corona Society in Trivandrum and prepared P&L Account & Balance Sheet for the FY22-23.
- Analyzed financial documents of companies like KELTRON LTD, KSRTC LTD, JJ BUILDERS to detect financial inconsistencies and relationships.
- Completed basic filing of Income Tax Returns (ITRs) for individual and corporate clients, achieving on-time submission and reducing penalties through careful documentation.