Insurance Claims Coverage

Prachi Kanojiya

R/N **** Sara Apartment *nd Floor Vangani west 421503 Tal – Ambernath Dist - Thane

Email Address : ***************@*****.***

Phone : 969-***-**** / 992-***-****

Career Objective

I want a highly rewarding career where I can use my skills and knowledge for organizational and personal growth.

Work Experience

Kokilaben Dhirubhai Ambani Hospital (KDAH) Navi Mumbai (1.5 months) Worked as a TPA Executive –

Maintain detailed and organized records of claims.

Process insurance claims accurately and in a timely manner.

Handle inquiries from clients, employees, and vendors professionally.

Maintain and update member records and plan documentation.

Processing of Preauths Solving Queries and Upload Final Bills to Insurance Portals and emails.

Attached Contracts to Approvals for Billing.

Suyash Hospital Seawoods. (1 Year)

Worked as a Claims & ESIC Executive -

Verify the patient’s insurance policy details and coverage.

Get pre-authorization & Final Approvals from the insurance company for cashless treatment.

Process cashless claims and reimbursements.

Ensure timely clearance of hospital bills through cashless claim approvals.

Validate the bills and treatment costs against the insurance coverage & Reduce discrepancies in hospital bills and prevent overcharging.

Handling Insurance and ESIC Portals for Initimate admissions and checking Approvals.

Sfurti Hospital Badlapur. ( 2 years )

Worked as a TPA Executive -

Sending Preauths and Final Bills to Insurance Company.

Scanning Documents & Solved queries of Patients.

Sending Emails and Handling Insurance Portals.

Investigate and resolve the Settlement issues.

Submitting claims to the insurer and ensuring payments are received.

Handle communication between the hospital and insurer for pending payments.

Collect required documents from the hospital for claim submission.

Advantegis solutions Pvt.Ltd (6 Months)

Worked as a Back Office Executive -

Entering, updating, and maintaining records in databases or systems.

Creating, updating, and filing reports, forms, or contracts.

Prepare daily activity report and handling excels data & organizing and managing physical and digital documents.

Communicating with other departments to resolve customer issues or concerns. Academic Qualification

Completed Graduation in Bachelor of Commerce from Mumbai University in 2023-24.

Completed HSC from Maharashtra State board in 2021-22.

Completed SSC from Maharashtra State board in 2019-20. Additional Skills-

DCA (DIPLOMA IN COMPUTER APPLICATION).

Familiar with Microsoft Software’s.

Personal Details

Date of Birth. : 23rd FEB 2003

Marital Status : Unmarried

Languages Known : English, Hindi, Marathi.

Hobbies : Swimming, Cycling, Trekking

Declaration

I hereby declare that the above mentioned information is correct to my knowledge and belief. Prachi Kanojiya

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