Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Affiliations
Timeline
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PRIYANKA DATHARAJ KONGARI

BALTIC,USA

Summary

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
PRIYANKA DATHARAJ KONGARI