Vishal Singh

About Vishal Singh

I am a US Healthcare Claims Associate with 1 year of experience in Claims Adjudication (Non-Voice), working on payer-side operations within the US healthcare insurance domain. I have hands-on experience in reviewing and adjudicating medical claims while ensuring compliance with payer guidelines, HIPAA regulations, and quality standards.My core expertise includes US healthcare claims processing, CPT and ICD-10 code validation, medical record review, claim adjustments, and denial analysis. I have consistently delivered high accuracy (99.33%), met productivity targets, and adhered to TAT/SLA requirements in a fast-paced MNC environment.I am well-versed in the end-to-end claims lifecycle, from intake and review to final adjudication, and have worked with tools such as Pega Claims Examiner, FileNet Image Viewer, and Member 360. I bring strong analytical skills, attention to detail, and a quality-focused approach to backend healthcare operations.I am currently seeking opportunities with reputed MNC healthcare organizations where I can leverage my claims adjudication experience, contribute to operational excellence, and grow professionally within global healthcare processes.Key Skills:US Healthcare Claims | Claims Adjudication (Non-Voice)| CPT | ICD-10 | DX Codes | Claim Adjustments | Denial Management | Payer Guidelines | HIPAA Compliance | Quality & Accuracy | US Insurance.

Experience

1. Claims Associate

   Carelon Global Solutions India

   Oct 2024 — Present · Gurugram, IN

   Adjudicated US healthcare claims in accordance with payer-specific policies, benefit plans, and processing guidelines• Reviewed and analyzed medical records, EOBs, and claim documentation for accurate claim determination• Validated CPT, ICD-10, and diagnosis codes as per medical necessity and payer rules• Performed claim adjustments, corrections, and reprocessing to ensure accurate reimbursement• Identified denial reasons and discrepancies to improve first-pass claim resolution• Ensured strict adherence to HIPAA compliance, data privacy, and internal quality standards• Consistently met productivity benchmarks, TAT, and SLA requirements• Maintained 99.33% quality accuracy, contributing to overall process efficiency

Education

• Maharshi Dayanand University

  Master of Business Administration - MBA, Finance, General

• Maharshi Dayanand University

  Bachelor of Business Administration - BBA, Business Administration and Management, General

  2021 — 2024

• Maharshi Dayanand University

  Bachelor of Business Administration - BBA, Business Administration and Management, General