Adv. Ajit kumar Mishra

To pursue a challenging career in a growth-oriented organization that offers ample opportunities to develop and refine my professional skills. I aim to contribute to the organization's success by providing a professional approach to every task I undertake. As an enthusiastic, hardworking, and open-minded individual, I am eager to put my knowledge to the best use, while continuing to learn and grow.

I possess strong analytical, communication, and interpersonal skills, and am committed to delivering high-quality results.

Internship - Y.S. Tyagi & Associates - C-216, Sector-10, Noida-201301

(2019-04 - 2019-06)

Gained hands-on experience in legal research, case drafting, and assisting with client consultations in civil and corporate law cases.

Internship - Anand and Anand - Plot No. 17 A, Sector-16A, Noida-201301

(2019-08 - 2019-08)

Contributed to research on intellectual property law, drafted legal opinions, and supported senior attorneys in preparing for hearings and proceedings.

Juniorship Advocate - Devesh Goyela & Associates - E-717 Lawyer Chamber, Karkardooma Court, Delhi; B-50, Basement, Surajmal Vihar, Delhi

(2019-09 - 2020-03)

Health Insurance Claims Executive | Non-Medico Claims Processing - SPECTRUM

(2020-03 - 2022-01)

Managed Health Insurance Claims Processing with focus on Claim Health Insurance Claims • Claims Processing • Claims Assessment • Claim Admissibility • Cashless Claims • Pre-Authorization • Bill Scrutiny • Document Verification • Non-Payable Items • Claim Discrepancy • Claim Investigation • Fraud Indicators • Risk Assessment • Loss Mitigation • Claim Leakage • Cost Containment • SOP • SLA • Compliance.

Health Insurance Claims Executive - HEALTH INSURANCE CLAIMS PROCESSING | NON-MEDICO - A36, A block, sector 64, Noida- 201301

(2022-01)

• Managed Health Insurance Claims Processing across cashless claims, pre-authorization, cashless discharge, OPD claims, hospitalization claims, and supplementary hospitalization claims.
• Performed Claims Assessment and Claim Admissibility checks based on policy coverage, terms & conditions, exclusions, waiting periods, sub-limits, deductibles, co-pay, and applicable benefits.
• Conducted detailed Bill Scrutiny and Document Verification to validate claim amounts and supporting documents.
• Identified and highlighted Non-Payable Items, Inadmissible Expenses, Non-Covered Items, Deductions, Discounts, and Policy Exclusions during claim processing.
• Identified and highlighted claim discrepancies and inconsistencies in bills, discharge summaries, prescriptions, diagnostic reports, claim forms, and other supporting documents.
• Cross-checked claimed expenses and payable amounts against policy terms, conditions, coverage, and applicable claim guidelines.
• Identified duplicate, unsupported, excessive, or unusual expenses and escalated cases for clarification, investigation, or appropriate deduction.
• Supported Claim Investigation, Risk Assessment, Loss Mitigation, Cost Containment, and Claim Leakage Prevention through systematic claim and document scrutiny.
• Identified potential Fraud Indicators and high-risk claim patterns and highlighted cases for further investigation as per defined processes.
• Coordinated hospitals, internal claims teams, investigation teams, and other stakeholders for resolution of claim discrepancies and documentation requirements.
• Ensured adherence to SOPs, SLAs, Claims Quality Standards, Policy Guidelines, and Compliance Requirements throughout the claim lifecycle.
• Maintained accurate claim observations, discrepancy details, supporting documents, and processing records to support quality and audit requirements.
• Contributed to accurate claim settlement and financial loss prevention by ensuring that non-payable and inadmissible expenses were appropriately identified and highlighted.

LL.B. - Law - Chaudhary Charan Singh University (CCSU) (2021)

B.A. - Economics - DR.RMLAU (2016)

Intermediate - PCM - U.P. Board, Allahabad (2013)

Matriculation - Science - U.P. Board, Patna (2011)