Bringing 7 years of related experience in Capable of Claims Representative adept at claims investigations, information review and settlement management. Positive and reliable professional with a detail-oriented and systematic approach.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Senior Claims Associate
Legatotechnology
Hyderabad, TELANAGANA
08.2019 - 06.2023
Utilized insurance software and databases to accurately document claim details and update claim status, achieving a 98% accuracy rate
Participated in training sessions to stay updated on industry regulations and best practices, contributing to a 10% increase in team efficiency
Identified errors or discrepancies in claims documents and worked collaboratively with other departments to resolve them promptly
Investigated potential fraudulent activity by reviewing suspicious claim submissions
Claims Associate
optum global solutions
Hyderabad, Telangana
08.2016 - 07.2019
Collaborated with other departments within the organization to address multi-faceted problems that required interdepartmental solutions
Conducted thorough investigations into complex claims, resulting in a 15% decrease in fraudulent claims payouts
Provided exceptional customer service by handling 100+ claim inquiries per day via phone and email, maintaining a 95% satisfaction rate
Education
Master of Science - BUSINESS ANALYTICS
University of New Haven
West Haven, CT
05.2025
MBA - Human Resources Development
CSA INSTITUTE OF PG COLLEGE
HYDERABAD
06.2018
Skills
Guidewire ClaimCenter
Duck Creek Claims
Salesforce
Zoho CRM
Document Management Systems (DocuWare, Laserfiche)
Tableau
Power BI
Microsoft Office Suite (Word, advanced Excel, Outlook)
Settlement Negotiation
Coverage Determination
Data Analysis
Investigative abilities
Claims Investigation
Microsoft Office
Decision-Making
Settlement determinations
Policy understanding
Documentation research
Interpersonal Communication
Settlement agreements
Financial Acumen
Certification
Certified Claims Professional (CCP)
Associate in Claims (AIC)
Insurance Fraud Investigator (IFI)
Customer Service Excellence Certification
Insurance Adjuster License
State-Specific Insurance License
Property and Casualty Insurance License
Life and Health Insurance License
Accomplishments
Employee of the Month: Recognized for consistently exceeding performance targets and demonstrating exceptional customer service skills.
Outstanding Achievement Award: Awarded for exemplary handling of complex insurance claims and dedication to ensuring fair and prompt resolutions.
Successfully processed and resolved over 500 insurance claims with a 98% accuracy rate, contributing to high customer satisfaction and retention.
Implemented efficiency improvements in claim processing workflows, reducing average claim handling time by 15%.
Received positive feedback from supervisors and colleagues for professionalism, attention to detail, and ability to handle high-pressure situations effectively.
Affiliations
Achieved 98% Accuracy Rate: Demonstrated exceptional attention to detail and proficiency with insurance software, leading to a 98% accuracy rate in documenting and updating claim details.
Increased Team Efficiency by 10%: Contributed to a significant boost in team productivity by participating in ongoing training sessions and implementing best practices.
Reduced Fraudulent Claims Payouts by 15%: Played a key role in identifying and investigating fraudulent claims, resulting in a 15% decrease in fraudulent claims payouts.
Maintained 95% Customer Satisfaction Rate: Provided high-quality customer service by managing over 100 claim inquiries per day and maintaining a 95% satisfaction rate.
Timeline
Senior Claims Associate
Legatotechnology
08.2019 - 06.2023
Claims Associate
optum global solutions
08.2016 - 07.2019
Master of Science - BUSINESS ANALYTICS
University of New Haven
MBA - Human Resources Development
CSA INSTITUTE OF PG COLLEGE
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