• Proactively researched and resolved insurance claims submitted by physicians or providers by analyzing the root cause and provided root cause remediation with 100% quality.• Demonstrated ability to achieve the monthly targets with 110% production for resolving the cases within the turnaround time and also supported the team for shared outcomes.• Proactively liaised with claim investigators, both domestically and internationally, steering investigative processes for claims requiring additional scrutiny and also contributed to new projects showcasing adaptability and expertise in Implementing new concepts and processes.• Actively verified member's eligibility and prior authorizations with the help of tools and internal resolution partners to reduce clam denials.• Demonstrated ability to complete documentation of final appeal outcomes using appropriate templates and communicating the same to Doctors or group of Hospitals.• Rendered decision for non-clinical complaints using sound, fact-based decision making.

• Proactively called insurance companies and conducted timely follow ups on open or pending claims, to ensure claims progress efficiently.• Adeptly collaborated with different departments at Insurance companies to resolve account discrepancies and steer claims process effectively.• Actively contributed to report preparation for all the claims that are followed up from insurance companies• Skillfully prepared written appeals on provider's behalf and sent to insurance companies for reconsideration• Identified and resolved systematic and operational root causes of denials and outstanding AR to enhance operational efficiency and mitigate potential risk.