Nikhat Afreen Email & Phone Number

An experienced and detail-oriented Claim Adjudicator with over two years of expertise in U.S. healthcare claims processing. Proven ability to efficiently review, analyze, and adjudicate claims while ensuring accuracy and compliance with industry standards. Skilled in working with cross-functional teams, resolving discrepancies, and utilizing healthcare claims management software to streamline operations. Strong analytical and critical thinking skills, with a track record of improving claims processing efficiency. Dedicated to maintaining high standards of customer service, confidentiality, and adherence to regulatory requirements, including HIPAA compliance.Key skills include process expertise, proficiency in U.S. healthcare claim adjudication software, and strong communication abilities. Fluent in English, Urdu, and Hindi.

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  Senior Process Associate

  Wipro

  Dec 2021 - May 2024 - Kolkata, West Bengal, India

  Reviewed and analyzed various types of insurance claims to ensure accuracy and compliance with company policies and regulatory requirements.Evaluated medical documentation and billing codes to determine claim validity and ensure appropriate payment.Communicated with healthcare providers and policyholders to clarify claim details, resolve discrepancies, and provide updates on claim status.Applied knowledge of relevant regulations and policies to make informed adjudication decisions, minimizing errors and maximizing efficiency.Processed claims within established timelines, adhering to service level agreements and maintaining high standards of accuracy.Utilized claims management systems and software to document decisions, maintain records, and track claim statuses effectively.Collaborated with cross-functional teams (e.g., underwriters, customer service) to address complex claims and improve overall claims processing.Identified and reported trends or issues related to claim processing, contributing to continuous improvement initiatives and policy updates.Maintained confidentiality and compliance with HIPAA regulations in handling sensitive patient information and claim data.Participated in training and development programs to enhance knowledge of industry trends, claim processing techniques, and regulatory changes.