Kanika Chauhan

Claims Associate @Carelon Global Solutions India

Gurugram, IN

Fraud Detection & Cost Containment: Support departmental objectives by thoroughly investigating potential fraud cases and escalating suspicious activities to mitigate financial risks and ensure compliance with company policies.• Claim Denial Reduction: Effectively reduce claim denial rates by accurately interpreting and applying policy guidelines and benefit coverage limitations, ensuring claims are processed correctly and efficiently.• Handling High Workloads: Demonstrate resilience and high productivity during busy periods by maintaining a high level of performance despite increased workload and time pressures.• Claim Resolution: Expedite the resolution of claims by proactively following up on pending claims, working closely with healthcare providers, and coordinating with insurance carriers to ensure timely and accurate outcomes.• Time Management & Prioritization: Manage multiple competing priorities, consistently meeting critical deadlines and maintaining organization even during peak work periods.• Policy Development: Contribute to the development and refinement of departmental policies to enhance operational effectiveness and improve the overall efficiency of the medical claims unit.• Mentorship & Training: Assist new hires by providing guidance, answering questions, and sharing best practices to help them integrate smoothly and excel in the medical claims field.• Process Improvement Initiatives: Actively contribute to company-wide initiatives to identify and implement process improvements, optimizing the medical claims function and overall workflow.• Customer Service Excellence: Enhance customer service quality by addressing inquiries promptly, providing clear explanations of complex medical claims concepts, and ensuring customers understand their benefits.