Rithik Dugar
Claims Associate | US Healthcare Insurance |
- Role
- Claims Associate at Carelon Global Solutions India
- Location
- Hyderabad, TG, IN
- LinkedIn followers
- 500 followers
About Rithik Dugar
As a meticulous & detailed driven Claims Associate with 2+years of experience in the healthcare insurance operation sector( Payer side), I excel in optimizing claims processing and resolving complex Medicare New day claims for Government Business Division (GBD) ensuring seamless interactions between healthcare providers, patients.
Experience
Claims Associate
Carelon Global Solutions India
Mar 2023 — Present · Hyderabad, IN
As an analyst my role is to Specializing in the timely and accurate processing of healthcare claims, ensuring seamless reimbursement experiences for providers and patients alike. My expertise includes:Authorization, Coordination of benifits, Corrected claims, Clinical trials, SNF, Acute inpatient,Ceris claims-Receive and review medical claims submissions from healthcare providers- Verify patient eligibility, coverage, and policy terms- Apply clinical guidelines and medical necessity criteria- Determine claim approval, denial, or pend status- Conduct thorough investigations and research to resolve complex claims issues- Identify opportunities for process improvements and implement changes to enhance efficiency and accuracyCurrently working on Medicare - Professional, Inpatient, outpatient claims & Medicaid Claims.Using Tools- Facets, Maces,Pega application,ACMP, Provider Portal.
Education
St Mary's centenary degree College
Bachelor of Business Administration - BBA, Business Administration and Management, General
2019 — 2022
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