Mrs. Tejasvi Rahul Tiwale

*** ***** ****,

Near apollo Theater,

Pune 411011.

Phone No. 845-***-****

Email ID: ad0vrd@r.postjobfree.com

PROFESSIONAL SUMMARY:

I have 8+ years of experience in insurance claim process. Worked smartly the way the industry demands. My sphere of interest lies by gaining knowledge to grow personally and share the growth with the organization. Energetic with strong time management skills who thrives in a fast-paced, dynamic environment.

EXPERIENCE SUMMARY:

1. Organization: MDI NETWORX PVT LTD.

Duration: From July 2021 to June 2022

Designation: - Senior Executive (US Healthcare Insurance process).

ROLES & RESPONSIBILITIES

Familiar with quick link software.

Worked on MAA (MID AID ASSOCIATE) claims from Nov 2021 to April 2022.

Attended daily client training call with team.

Having project handling experience for 6 months. Daily production of 65 claims.

Prepared daily production reports and shared with senior management and clients.

Gathered and verified all required claims related information for tracking purposes.

Documented accurately, researched, and resolved claims issues.

Reviewed & worked on client escalation mail.

Done internal audit to improve quality of processing.

Scheduled daily call with quality team & client document to get new update.

Worked on high dollar value claims on priority.

Worked on ageing claims.

2. Organization: COGNIZANT TECHNOLOGY SOLUTIONS PVT. LTD.

Duration: From July 2016 to July 2018

Designation: Senior Executive (US Healthcare Insurance process).

ROLES & RESPONSIBILITIES

Worked on CWHP & Mercy, Medicaid Project.

Effectively managed a high-volume of inventory.

Monitored claims to ensure accuracy of CPT, ICD-9, and HCPCS coding.

Gathered and verified all required claims related information for tracking purposes.

Attended daily client training call with team.

Also have knowledge of void, refund, reissue & adjustment claim.

Accurately documented, researched, and resolved claims issues.

Maintained daily production report & shared with senior member as well as report to client.

Conduct regular audits of random claims for purposes of quality assurance.

Coordinate with other insurance (Medicare and Medicaid) to apply correct benefit for copays, coinsurance, and deductibles.

3. Organization: - IBM DAKSH PVT LTD.

Duration: - From 28th Jan 2011 to May 2016

Designation: Senior Executive (US Healthcare Insurance process).

KEY RESPONSIBILITES: -

Worked with Highmark Medi-claim Insurance process.

Experience with data entry, excellent accuracy.

Knowledge of ICD-10 diagnosis code & CPT procedure code.

Knowledge of on Medicare, Medicaid & BlueCross BlueShield.

Experience with claims professionals & Institutional.

Worked on client priority data.

Processed Claims for FEP, HMO/PPO Claims.

Trained new joiner.

Conduct regular audits of random claims for purposes of quality assurance.

Assigned claims to team member.

Handled Critical & Aging Claim.

Ensured Data accuracy in close co-ordination within the team.

Maintained client SLA with 100% accuracy.

As per the suspensions finalizing the claims to approve or reject.

Maintained documents and reports generation based on error made monthly.

EDUCATIONAL QUALIFICATION:

●S.S.C Passed from Maharashtra State Board in 2003. 1St Class

●H.S.C Passed from Maharashtra State Board in 2005 (Commerce). 1st Class

●T.Y. B Com. Passed from Pune University in 2008 (Work and cost accounting) IInd Class.

PERSONAL DETAILS:

●Date of Birth : 1st October 1987

●Place of Birth : Pune

●Nationality : Indian

●Marital Status : Married

●Gender : Female

COMPUTER SKILLS:

Computerized Accounting (Version 6.3 and 7.2) and Office Automation. Passed From Bombay University in First Class.

HOBBIES / INTEREST:

Listening Music.

Cooking

LANGUAGES KNOWN:

English, Hindi, & Marathi

DECLARATION:

I hereby declare that all the information provided above is true to best of my knowledge and belief.

Place: Pune

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