Vinaykumar C Patil

Bangalore

Summary

Dynamic Claim Associate with 2.3 years at Carelon Global Solution, adept in adjudicating and negotiating health insurance claims. Proven expertise in claims processing documentation and effective communication, ensuring timely resolution of provider disputes. A quick learner committed to enhancing operational efficiency and delivering exceptional results in the US healthcare domain.

Overview

years of professional experience

Certification

Work History

Claim Associate

Carelon Global Solution

Bangalore

03.2022 - 07.2024

Company Overview: Having 2.3 years of corporate experience in US health care domain.
Adjudication and adjustments of claims.
Reviewing, researching, investigation, negotiating, and adjusting health insurance claims.
End to end processes in Medicare advantage, HMO, PPO and POS claims, Such as professional outpatient and inpatient claims, with all the subject knowledge of the new day claims.
Handling Provider dispute in a timely manner in order to resolve the provider dispute/claim denial( Enquiry tracking).
Raising content ( Manual letters to provider)
Applying benefits according to the provider/ member contractual benefits
Maintaining MOM for the team huddles .

Education

BCOM -

VSMs Degree College

Nipani

01.2021

Commerce - PUC -

GI Bagewadi College

Nipani

01.2019

Skills

MS Application
FACET Application
CITRIX workspace

Claims processing documentation
Effective communication skill
Quick learner

Languages

English
Kannada
Marathi
Hindi