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Claims Associate Resume Example

Resume Score: 65%

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CLAIMS ASSOCIATE
Professional Summary
Seeking an entry level assignment in Bpo organization of high repute, Growth oriented organization preferably in Any Sector; to work for an Esteemed Organization where I can enhance my knowledge & Skill's there by contributing towards the achievement of the Organization's Goals. I hereby declare that the above written particulars are true to the best of my knowledge and belief. (Ankith Solanki) Adaptable healthcare administrator accustomed to the integration of new healthcare delivery systems and restructuring of work in an increasingly complex regulatory environment. Accomplished [Job Title] who proudly maintains a highly productive, efficient and quality-driven environment at all times. Innovative, customer-oriented healthcare administrator with background in managed, ambulatory and long-term care. Strong background in quality assurance, claims analysis and management principles and practices. Seeking a leadership role within an integrated delivery system. Highly analytical healthcare management professional combining more than [number] years of work in long term care with proficiency in financial management, leadership and positive clinical outcomes. [Job Title] skilled at communicating, organizing and solving problems to raise the stature and rankings of health care facilities. Well-trained [Job Title] offering vast experience in medical operations, excellent interpersonal communication skills and the organizational savvy to run a hospital facility smoothly.
Skills
    Windows-XP, Windows 98, Tally9
  • Strong presentation skills
  • Strategic planning capability
  • Planning and development
  • Analytical thinker
  • Talented interviewer
  • Accomplished leader
  • Independent judgment and decision making
Languages
Languages Known : English, Hindi, Telugu & Marwari
Work History
Claims Associate06/2014 to 11/2015
Company Name – City, State
  • Worked with UHG health care process, Overall 17 months Experience in BPO sector.
  • Processing the claims on various reviews for united health group.
  • Finding out possible duplicates of claims.
  • Working on aged claims for release of payment within Timely Filing Limit.
  • Verifying correct notifications and attaching notifications to the claims.
  • Finding out medical necessity for the claim and process accordingly.
  • Sending inaccurately processed claims to Field services for adjustments and corrections.
  • Deep observation on provider selection and specialty as per ICD and CPT codes.
  • Processing claims and sending claims for next level of processing (Payment Issue Department) Top performer for every month.
  • In college and school level actively participated in debate and essay competition and received appreciation from higher levels.
  • Ability to work hard.
  • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
  • Developed and achieved financial and growth goals.
  • Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating a proactive work environment.
  • Supervised and managed the daily activities of a clinical team consisting of [number] physicians, nurses and support staff.

Education
MBA: Finance2017Buds and Flowers High School- City, State
M.B.A: FinanceGeorgia Christian University- Finance
Bachelors of Commerce: Accounts,Marketing,Finance,Management Accounting,Fundamentals of Information Technology2013St. Joseph's Degree and P.G College- City, State
Intermediate: Mathematics,Economics,Commerce2010Sri Chaitanya Jr. College- City, State
S.S.C: 2008Buds and Flowers High School-
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Resume Overview

School Attended

  • Buds and Flowers High School
  • Georgia Christian University
  • St. Joseph's Degree and P.G College
  • Sri Chaitanya Jr. College

Job Titles Held:

  • Claims Associate

Degrees

  • MBA : Finance 2017
    M.B.A : Finance
    Bachelors of Commerce : Accounts,Marketing,Finance,Management Accounting,Fundamentals of Information Technology 2013
    Intermediate : Mathematics,Economics,Commerce 2010
    S.S.C : 2008

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