Sandeep H

Experience

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  Carelon Global Solutions

  Dec 2020 - now

  • Problem solving and being goal-oriented and capable of delivering a high level of accuracy.• Responsible for processing applications submitted by members/applicants into the system accurately within the TAT.• Handle various Appeals made by applicants on different issues include researching, resolving, and documenting issues.• Tracks claim detail errors and communicates to up-line management for coaching and training purposes.• Consistently meet established productivity, schedule adherence, and quality standards.• Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures.• Responsible for verifying documents sent from providers for further processing of the claim.• Communicating with clients for process-related queries.• Connecting with providers via call for obtaining the required information for further processing of the claim.Skills:Tools – Blue square, Excel, Word, HippaEDI, BPM, WCF, NPPES.Mentoring - Mentored new joiners, clarifying their doubts and helping them manage their work on timely manner.Shared Responsibilities – Audited the claims and conducted error session for quality improvement of the team.Multiple responsibilities – worked on multiple queue’s and process’s to help the team manage the TAT and worked on Escalations emails. Show less

  • Claims Associate

    Dec 2020 - now

  • Claims Analyst

    Dec 2020 - Jul 2023