Riti Vohra

Seattle, WA ***** 201-***-**** acvsku@r.postjobfree.com

Profile

Customer-focused Benefits Administrator and Claims Associate with proven capabilities in researching complex issues, examining plan provisions, and adjudicating claims made by in-network/out-of-network health providers. Skilled in Medicare/Medicaid claims processing. Communicate effectively with insurance providers, technical teams, and Client HR team. Administers enrollments, terminations, and employee changes in group benefit programs. Produce reports, resolve inquiries, and update records relating to payroll deductions and health insurance coverage, monitoring system jobs related to plan benefits. Recognized for integrity and high degree of professionalism. Fully authorized to work in the U.S.

Professional Experience

Aon Hewitt Pvt. Ltd., Noida, India 2012 – 2014

Benefits Operations Administrator

Supported Discover Financial Services client by resolving participant issues, which involved conducting research, analyzing plan provisions, and translating provisions to the ongoing processing environment. Generated, reviewed, and updated client-specific documents. Completed manual processing, calculations, and financial adjustments on health care accounts of individual Discover Financial Services participants to fix salary deduction issues.

Created tasks for technical team to resolve system flaws and liaised with team regarding technology, shared services, and ongoing client processing to ensure accurate, on-time assignment completions.

Prepared standard operating procedures (SOPs) in accordance with client requirements.

Trained new and existing team members on query resolution, system processes and edits, SOP creation, and development of end-of-day production files.

Executed ad-hoc requests, exception requests, and appropriate follow-ups.

Administered system processes on daily, weekly, and monthly basis, including performance verification of the following: HR, Evidence of Insurability (EOI), payroll deduction, wellness, absent, and Cobra termination file management systems.

Regularly exceeded target metrics: Evaluated measures included zero client penalties and escalations, 100% task adherence, 95%+ client request resolution, active participation in training sessions, and 100% compliance on HR guidelines.

Based on superior performance, assigned to help support and stabilize key client (Caesar’s Entertainment).

Serviced the needs of Caesar’s Entertainment from day one implementation in H/W (health and welfare) benefits administration. Helped in making the client go live by creating/documenting client SOPs and evaluating summary plan descriptions (SPDs) for daily, weekly,and monthly jobs. Performed high-volume workflow management, closing more than 50 queries per day. Trained new hires.

Assisted technical team in designing tasks/processes by defining business requirements. Coordinated with team to set day and time to run jobs automatically based on requirements; continuously tracked job status.

Administrated jobs and performed random quality checks on tasks assigned to system; reviewed and signed off on escalated jobs.

Manually updated employee records in TBA software from vendor conversion files. Added beneficiaries; updated insurance through qualified events such as Cobra termination; and revised employee accounts in relation to salary calculations, payroll adjustments, health insurance coverage, and coverage categories.

Monitored client’s direct mailbox to work on escalated issues and fix accounts.

Received several quality and achievement awards for fixing record number of workflow issues with client.

Riti Vohra

Page 2-201-***-**** acvsku@r.postjobfree.com

Professional Experience – continued

United Health Group Pvt. Ltd., Gurgaon, India 2010 – 2011

Claims Associate

Adjudicated and paid medical, Medicaid, and Medicare claims made by U.S. health service providers, both in network and out of network, by calculating coinsurance, copay, and deductible. Calculated allowable amount, patient responsibility, and provider write-off on Medicare and other insurance claims.

Adjudicated claims with cause code for preventive care, general illness, and maternity, including physician and facility as well as surgery, therapy, and office visit claims with various modifiers, CPT, and HCPC codes. Coordinated and adjudicated claims with other insurances, Medicare, and Medicaid.

Distributed letters to U.S. service providers and Medicaid.

Bank of America Continuum Solution Pvt. Ltd., Gurgaon, India 2007 – 2009

Research Associate

Researched missing, misapplied, and misdirected payments of credit card customers, along with investigating check, pay-by-phone, and online payments. Received customer correspondence requesting credit balance refund and merchant credit on account.

Credited cardholder/merchant accounts. Debited cardholder account for credit balance refund amount and issued check for same amount.

Removed late fee and finance charges from credit card as necessary; modified annual percentage rates on credit card due to bank error; corrected inaccuracies in customers’ credit histories.

Closed accounts at cardholder request. Submitted letters to customers.

Education

Management Education and Research Institute (MERI) – IP University, New Delhi, India

Post Graduate Diploma in Business Management (PGDBM)

Panjab University, Chandigarh, India

Bachelor in Arts and Humanities

Contact this candidate