Rahul Gupta

Experience

1. Benefits Analyst

   Carelon Global Solutions India

   Jan 2025 — Present · Gurugram, IN

   Responsible for designing the health plan benefits, including coverage levels, deductibles, copays, coinsurance, and maximum out-of-pocket limits. • Responsible for configuring the health plan\'s benefit structures in the insurance company\'s claims processing system. This involves ensuring that the benefits are accurately and consistently set up and that any changes to the benefit design are reflected in the system. • Knowledgeable in HIPAA, Medicare, and Medicaid. • Knowledge of healthcare products like PPO, EPO, HMO, HDHP, CDHP, SHIP, and POS • Hands-on experience in JIRA, SALESFORCE, FRONT OFFICE BENEFITS (FOBS), WPD, INCLUSION TOOL, and WGS applications, testing, and configuration tools. • As a benefit coder at Elevance, responsibilities include coding and maintaining health insurance benefits and plan designs in the WPD system. • Ensuring that all benefits and plan designs are accurately reflected in the WPD system and aligned with regulatory requirements. • Collaborating with product managers, actuaries, and other stakeholders to ensure that benefit and plan design changes are accurately reflected in the system. • Analyzing and interpreting benefit and plan design data to identify trends and make recommendations for improvements. • Reporting benefits plan information to upper management.

Education

• University School of Management Studies, GGSIPU

  Bachelor of Business Administration - BBA

  2019 — 2022

• Prabhu Dayal Public School

  11

  2006 — 2019