Nagesh R.

About Nagesh R.

Experienced professional with 3+years in healthcare and benefits administration, currently serving as an Associate Benefits Analyst at Carelon Global Solutions. Skilled in claims processing, benefits analysis, and client management, with a proven track record at Accenture (US healthcare claims) and Crown Solutions (Process Associate). Demonstrated understanding of appeals and grievances processes, with 3+ years of experience in Medicare and Medicaid regulations and compliance.*Experience I can act as a key liaison between Leadership and internal/external stakeholders, ensuring smooth coordination and execution of various initiatives, coach knowledge about US Healthcare plans in detailed, hippa, and tat. I can use critical thinking ability to determine what to do, what not to do. I can be able to understand technical software tools which we can use to create Healthcare claims *Skills Experienced Associate Benefits analyst trained in US Healthcare claims process, HIPAA, medicare, medicaid, EOC (evidence of coverage), SOB/SBC (summary of benefits and Coverages), TAT, SLA and KPI. Worked states for Indiana, Virginia, Kentucky, Missouri, Ohio, New Hampshire, Maine and Connecticut.*Career highlights Delivered 100% on Production targets for 36 consecutive months.

Experience

1. Associate Benefits Analyst

   Carelon Global Solutions India

   Oct 2023 — Present · Bengaluru, IN

   gather information about the client *code cost shares in P2A tool*edit EOC document as per state wise Impact*Achieved 100% quality and production *followed company guidelines and *met tat and kpiAwards*received proper management attention for process EOC Documents correctly *appreciated for good listener in the training time

Education

• Adhiparasakthi college of arts and science

  Bachelor's degree, Computer applications Score: 61%

  2015 — 2018

• Indo american school

  SSLC, General Studies Score: 82%

  2012 — 2013

• Indo american school

  HSC, Computer Science Score: 63%

  2014 — 2015