Summary
Overview
Work History
Education
Skills
Noteworthycredits
Personal Information
Hobbies and Interests
Timeline
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Rajitha Priyadarshini Jangam

Chambersburg,USA

Summary

Detail-oriented senior claims analyst professional in healthcare with over 4 years of experience in processing medical claims. Expertise in health insurance principles, regulations, and practices. Currently pursuing a master's degree in healthcare informatics from Harrisburg University. Comprehensive knowledge of subrogation, reinsurance, workers' compensation, third-party liability, and coordination of benefits. Proficient in analyzing and investigating claims, setting reserves, determining compensability, and facilitating claim settlements. Experienced in US Healthcare Provider and Medical Claims. Strong customer interaction skills ensure satisfaction and repeat business opportunities. Proven track record of maximizing customer satisfaction through prompt query resolution and efficient service delivery. Outstanding problem-solving, planning, team building, and management skills. Notable expertise in insurance and medical claims, quality assurance, requirement gathering, analysis, and investigation.

Overview

4
4
years of professional experience

Work History

Senior Process Executive-Voice

Cognizant Technology Solutions
02.2018 - 11.2020
  • Managed patient care services (PCS), including eligibility and pre-authorization for all payers
  • Efficiently processed DME authorizations and benefits, involving communication with insurance providers via phone, email, and regular mail.
  • Verified eligibility within a database system for members and providers
  • Analyzed faxed requests and documentation to determine coverage and approval criteria
  • Processed requests for prior authorization and coded diagnoses and procedures according to standards
  • Reviewed medical records before submitting them to insurance for authorization
  • Coordinated with sales representatives to ensure the submission of complete documentation
  • Utilized Salesforce application for efficient data management
  • Worked effectively in fast-paced environments.
  • Learned and adapted quickly to new technology and software applications.
  • Proved successful working within tight deadlines and a fast-paced environment.
  • Excellent communication skills, both verbal and written.
  • Self-motivated, with a strong sense of personal responsibility.

Process Analyst

Inventors Knowledge Solutions (IKS)
10.2016 - 12.2017
  • Processed medical claims for outpatient services, determined covered insurance losses, and established proof of loss
  • Collected and assembled additional information from various sources, including claimants, physicians, employers, hospitals, and other insurance companies
  • Handled standard claims, corrected claims, special handling claims, and service forms
  • Documented medical claims actions and resolved claims by approving/denying documentation
  • Ensured legal compliance and maintained quality customer service
  • Provided legal support and protected confidential claims information
  • Took initiative to clarify team queries and handle appeals based on claim denials and payments
  • Received awards for maintaining quality and effective team management

Education

Master’s degree - Healthcare Informatics

Harrisburg University of Science And Technology
Harrisburg, PA
04.2025

Bachelor's degree - JNTU

Vijaya College of Pharmacy

Intermediate -

Narayana Intensive Medical Academy

Matriculation -

Stanley girls High School

Skills

  • Citrix
  • NextGen
  • Intergy
  • MS Excel
  • MS Word
  • MS PowerPoint
  • Utilization Management
  • Security understanding
  • Claims Processing
  • Quality Assurance

Noteworthycredits

  • Received Star of the Month award for maintaining 100% Quality in Cognizant and IKS.
  • Achieved 100% external quality for 6 months in service forms processing in Cognizant.
  • Special appreciation award for effective team management in the absence of a manager in Cognizant.
  • Received client's special appreciation for quick responses and query resolution for multiple payers in IKS.
  • Received a Platinum award for overall performance of the year in Cognizant.

Personal Information

  • Date of Birth: 01/11/95
  • Nationality: Indian

Hobbies and Interests

  • Listening to Music
  • Writing poems/Quotes

Timeline

Senior Process Executive-Voice

Cognizant Technology Solutions
02.2018 - 11.2020

Process Analyst

Inventors Knowledge Solutions (IKS)
10.2016 - 12.2017

Master’s degree - Healthcare Informatics

Harrisburg University of Science And Technology

Bachelor's degree - JNTU

Vijaya College of Pharmacy

Intermediate -

Narayana Intensive Medical Academy

Matriculation -

Stanley girls High School

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Rajitha Priyadarshini Jangam