Srinath Doosa
Shakopee,MN
Summary
Results driven Claims Associate at Optum, United Health Group, skilled in claims investigation and verifying information. Proven track record in resolving complex claims and enhancing workflow efficiency. Adept at utilizing analytical tools to ensure compliance and improve processes, while delivering exceptional customer service and maintaining detailed records for management review.
Overview
3
3
years of professional experience
Work History
Claims Associate
Optum, UnitedHealth Group
07.2016 - 01.2019
- Process and adjudicate healthcare claims with accuracy and within turnaround time (TAT) requirements.
- Review claim submissions for completeness, validity, and compliance with company policies and healthcare regulations.
- Analyze medical documentation, coding, and policy coverage to determine claim eligibility.
- Investigate and resolve claim discrepancies, denials, and appeals in coordination with internal teams and external stakeholders.
- Communicate claim determinations to providers, members, and clients while maintaining excellent customer service.
- Work closely with healthcare providers and insurance representatives to verify patient eligibility and benefits.
- Identify trends in claim rejections and report recurring issues to senior management for resolution.
- Ensure compliance with HIPAA, insurance policies, and data privacy standards.
- Utilize company software, claims management systems, and analytical tools to track and manage claims efficiently.
- Participate in training sessions and continuous learning initiatives to stay updated on industry changes and claim processing guidelines.
- Assist in process improvement initiatives to enhance workflow efficiency and reduce errors.
- Support audits and quality control checks to ensure compliance with internal and external regulatory standards.
- Handle escalated claims and work with supervisors to resolve complex cases.
- Maintain detailed records of claim transactions and prepare reports as needed for management.
Skills
- Claims Investigation & Resolution
- Claims Processing
- Medical Coding
- Data Entry & Documentation
- Compliance & Regulatory Knowledge
- Claims Management Systems
Timeline
Claims Associate
Optum, UnitedHealth Group
07.2016 - 01.2019
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