Headline

Working

About

Claim Adjudication Specialist |Rework Cob|Medicare|Accelerated pay|High dollar review|Adjustment|Cats case appeal|PCR|Member & provider appeal|HIPPA|

Location

Gurugram

Work experience

Client Care Representative at Concentrix, Sep 2022 - Present · 3 yrs 9 mos, Gurugram, Haryana, India

Healthcare Representative at Concentrix, Sep 2022 - Present · 3 yrs 9 mos,  Process Efficiency & Compliance: Reviewed and processed customers' health insurance claims, ensuring compliance with the policy guidelines of Aetna. Adhered to regulatory requirements and maintained confidentiality of sensitive customer information.  Data Analysis & Validation: Analysed claim documentation and medical records to determine the eligible reimbursement amount. Maintained a high level of accuracy and attention to detail in processing claims to minimize errors and discrepancies.  Stakeholder Communication: Collaborated with insurance providers, healthcare professionals, and customers to gather necessary information and resolve claim-related inquiries. Effectively communicated claim decisions and provided explanations to customers, ensuring a positive customer experience.

Education

B.B.A, Human Resources Management/Personnel Administration, General, Chhatrapati Shahu Ji Maharaj University

High School Diploma, cbse