J P High School

CURRICULAM-VITAE

PRATEEK SHARMA

E-Mail- ***************@*****.***

Mob. – 959-***-****

PERMANENT ADDRESS:

S/O Anil Kumar Sharma

Moh. - Bahadurganj, Tilhar

District- Shahjahanpur (U.P) Pin- 242307

CAREER OBJECTIVE:

To obtain a position of responsibilities where I can grow my skills. Utilize my skills and knowledge to contribute to the overall success of the organization. ACADEMIC QUALIFICATION:

M. A. from M.J.P. Rohilkhand University, Bareilly in 2015

B. A. from M.J.P. Rohilkhand University, Bareilly in 2013

Intermediate from U. P. Board in 2008

High School from U. P. Board in 2006

COMPUTER SKILLS:

Very much friendly with MS Office

Well typing speed in English.

Working experience on SQL

EXPERIENCE:

(1) Conduent Business India LLP:

Designation: Sr. Associate

Tenure: From Dec 6, 2021, to till Present.

Work Profile:

In Conduent I’m handling STD, Absence Management Claims. COBRA Monthly Billing, Premium Refunds, Monthly Premium Fund transfer and Annual Enrollment. For processing the STD claims, I need to review many kinds of documents like Policy Contract, Employer Statement, Attending Physician Statement and Other Medical Record. For Absence Management Claims, I also need to verify the FMLA and other leaves eligibility. I also provide training and assistance to new employees. Resolve Complain and Queries of the insurer or beneficiaries via call, e-mail and chat. These Complain and Queries are related to their policy plan and provisions. If the insurer wants to make some changes in the coverage or plan, then we just make those changes based on the supporting Documents.

(2) Genpact India Pvt Ltd, Gurgaon:

Designation: Process Associate

Tenure: From Nov 22, 2019, to Dec 2, 2021.

Work Profile:

Here I’m handling the STD, SDI and Absence Management Claims. For processing the STD and SDI claim we need to review all the related documents very carefully like: Policy Contract, Group JA, ER statement and Attending Physician Statement. After reviewing these documents, we find out the following details like: Eligibility Period, Enrollment Period, Benefit Waiting Period, Policy Exclusions, Policy Limitations, EE’s Class, Policy Effective Dates, Maximum Benefit Period, Policy Contribution, Maximum Payable Benefit, Minimum Payable Benefit and many more. But for the Absence Claims we need to refer only to group specific JA and Health Certificate. In absence management claims we also review that, which kind of leave that employee have. If the employee has FMLA then we follow the FMLA guideline for processing the claim and if the EE has any employer sponsored leave, then we process that claim as per the employer statement. After receiving all the required documents, we make a Claim Summary with the initial claim decision.

(3) Optum Global Solution, Gurgaon:

Designation: Claim Associate

Process: Quest Diagnostics

Tenure: Oct 24, 2018, to June 7, 2019, as a part of Team “East OGS”.

Work Profile:

Working on the Denials and Manuals EOB’s and posting the payments on patient’s account. Retrieve missing EOB’s, find misdirected payments and refund the excess payment to the patient or insurance company as per the scenario. After posting all the payments I need to reconcile my batch.

(4) EXL Services, Noida:

Designation: Sr. Process Associate

Process: Prudential Financial (An American Life, Health and Group Insurance Company)

Tenure: July 1, 2015, to Sep 12, 2018, and have to done work in two teams, which are following:

(a) Prumatic (EFT)- July 1, 2015, to Dec 31, 2017

(b) Group Insurance Claims- Jan 1, 2018, to Sep 12, 2018,

Work Profile:

In team Prumatic:

Here my work was handled all request of the Prudential’s customer, it may be Add to EFT, Change Banking Information, remove from EFT, Skip Drafting, Redraft the Premium, Refund the excess Premium as per the client request or depend on policy removal date and send confirmation letters to the customers for their request. Working on many types of ILI policies like: Term, Whole life, Universal Life, Variable Life and Variable Universal Life Insurance policies. In team GI Claims:

It’s a group disability claim process. Here we received STD claims of that employees those are working in USA. For processing the claim, we need to read the Policy Contract, Group specific JA, Employer Statement and all Medical Documents which are received from the Employee and Employer. When we receive all the necessary information from the Employee and Employer then we create the Claim Summary and upload it with the appropriate decision like claim will be denied or approved. EXTRA ACTIVITIES:

Provide training to new joiners in both teams.

Give assistance to the all-team members in both teams.

Work assignment to other team members in GI Invoicing.

Doing quality audits for team members in GI Invoicing. STRENGTH:

Good learning skills.

Complete my work within a certain time with a good quality score.

Ability to deliver consistent results.

Implement some ideas in my work for reducing the processing time and increasing the quality. PERSONAL PROFILE:

Name : Prateek Sharma

Father’s Name : Anil Kumar Sharma

Date of Birth : 12

th

Dec. 1991

Marital Status : Married

Citizenship : India

Hobbies : Net Surfing and Gathering knowledge about Indian History. Language Known : Hindi & English

DECLARATION:

I hereby declare that the above information given by me is true and correct to the best of my knowledge. Place:

Date: (Prateek Sharma)

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