Headline

Managing cashless claims with strong customer service skills.

About

As a Claims Executive specializing in health insurance and TPA operations, I support hospitals, TPAs, and insurers in processing cashless and reimbursement claims with accuracy, speed, and a strong focus on customer satisfaction. With 7+ years of experience, I manage the full claim lifecycle—from pre-authorization and coverage verification to settlement and payment follow-up—for both individual and group health policies. My core strengths include cashless claim processing, TPA coordination, policy servicing, and resolving complex medical insurance queries while reducing rejections and improving turnaround times. I work comfortably in fast-paced environments, maintain high documentation standards, and use tools like Freshdesk, and MS Office to track claims and queries efficiently. Known for being patient, detail-oriented, and reliable, I handle sensitive and escalated cases with professionalism and empathy. I am open to opportunities as a Claims Executive, Insurance Coordinator, TPA Executive, or Cashless Claim Executive and welcome connections with hospitals, TPAs, insurers, and HR professionals in the health insurance space.

Location

Vadodara

Work experience

Executive - Cashless TPA at Saatvik Eye Hospital, Jun 2024 - May 2026 · 2 yrs, Vadodara, Gujarat, India, *Process and manage cashless insurance claims for patients, ensuring policy compliance and timely approvals from insurance companies.​ *Coordinate with insurers and TPAs for pre-authorization, claim approval, and payment status, maintaining clear communication at every stage.​ *Guide patients on treatment coverage by reviewing individual policies, explaining eligibility, and setting correct expectations.​ *Maintain detailed claim documentation and follow-up records until final payment, supporting audit readiness and transparency.​ *Support new hospital empanelment activities with insurance companies to expand provider networks and improve patient access

Claims Executive at Loop, Dec 2021 - Jun 2024 · 2 yrs 7 mos, Vadodara, Gujarat, India, *Handled 200+ monthly employee medical insurance queries via phone, email, and chat, delivering one-stop resolution with high first-contact success.​ *Processed and tracked medical claims for corporate employees, ensuring alignment with policy terms and reducing rejection rates through clear communication.​ *Coordinated claim submissions and status updates with insurance companies and TPAs on behalf of employees and corporate HR teams.​ *Maintained accurate claim and query records in Freshdesk, consistently meeting Service Level Agreements (SLA) for all assigned tickets

Customer Service Representative at HGS - Hinduja Global Solutions, Oct 2018 - Nov 2019 · 1 yr 2 mos, Charlottetown, Prince Edward Island, Canada, *Delivered customer support to 50+ customers daily in the billing department for a major telecommunications client.​ *Handled billing inquiries, requests, and complaints with professionalism, aiming to maintain high satisfaction scores.​ *Processed billing updates and adjustments accurately while following internal guidelines and compliance requirements.​ *Documented customer interactions in the CRM system to support quality checks and continuous service improvement

Executive at Dedicated Healthcare Services TPA (India) Pvt. Ltd., Sep 2016 - Nov 2017 · 1 yr 3 mos, Vadodara, Gujarat, India, *Processed medical claims for employees under group health insurance schemes, ensuring accurate data entry and documentation.​ *Coordinated with insurance companies on claim status and requirements, helping employees complete documentation and avoid delays.​ *Maintained organized records of all employee medical claims to support audits and regulatory compliance.​ *Communicated claim status and outcomes to employees via phone and email, ensuring clarity and timely updates

Education

HUMAN RESOURCE DEVELOPMENT, Human Resources Development, CVM Institute of Human Resource Development

Bachelor of Family and Community Science, Extension & communication, The Maharaja Sayajirao University of Baroda