Akileshwar Naidu

Results-driven Senior Claims Representative with 6+ years of progressive experience in end-to-end claims processing, insurance operations, reimbursement adjudication, and policy verification within global BPO and healthcare environments. Proven expertise in Salesforce CRM, Guidewire claims management, fraud detection, SLA adherence, First Contact Resolution (FCR), and Customer Satisfaction (CSAT) optimization. Adept at evaluating claim documentation including purchase invoices, payment receipts, and proof of ownership for Accident & Health (A&H), personal property, and medical claims.

Demonstrated success in cross-functional collaboration, regulatory compliance, data analysis, and mentoring new hires in fast-paced, high-volume operational settings.

Senior Claims Representative - Cigna Healthcare

(2023-12)

• Process and adjudicate end-to-end reimbursement claims for international clients including IKEA Furniture, personal property items, damaged/lost items, and medical claims, ensuring strict compliance with policy guidelines and client SLAs.
• Evaluate and validate supporting documentation — purchase invoices, payment receipts, proof of ownership, and claim details — to determine claim eligibility and reimbursement outcomes in line with coverage terms.
• Perform policy verification and coverage assessment to ensure accurate claims adjudication per client agreements, internal SOPs, and quality standards.
• Serve as primary point of contact for expatriate members and global clients, resolving complex claim-related concerns and delivering timely status updates with a customer-first approach.
• Utilize Salesforce CRM and enterprise claims management systems to document all claim activities, maintain accurate audit trails, and ensure seamless end-to-end claims handling.
• Collaborate with cross-functional operations, QA, and escalation teams to resolve claim discrepancies, reduce turnaround time (TAT), and improve overall customer satisfaction scores.
• Consistently maintain strong performance metrics: SLA adherence, First Contact Resolution (FCR), productivity targets, accuracy rates, and Customer Satisfaction (CSAT) benchmarks.
• Apply investigative and analytical skills to validate supporting evidence, detect irregularities, and flag potential fraud in reimbursement decisions.
• Handle high-volume inbound and outbound client interactions with professionalism, empathy, and accuracy in a fast-paced BPO environment.

Associate Claims Handler - WNS Global Services

(2022-06 - 2023-12)

• Supported global insurance clients through voice-based and written client servicing, addressing customer concerns related to Accident & Health (A&H) and personal injury claims.
• Managed end-to-end client communication across calls, emails, and written updates, ensuring customers were consistently informed throughout the full claims lifecycle.
• Assisted Claims Managers by liaising directly with clients, resulting in measurable improvements in client retention and satisfaction metrics.
• Ensured operational accuracy and regulatory compliance while balancing customer-first service delivery and adherence to internal quality standards.
• Trained and mentored new hires on voice process etiquette, claims handling procedures, and client-handling best practices, enabling smoother onboarding and accelerated performance ramp-up.
• Strengthened client trust through proactive communication strategies and timely claim status updates.

Customer Support Executive - BigBasket

(2020-06 - 2022-02)

• Delivered high-volume customer support during IST business hours, managing escalations, calls, and chat interactions with professionalism and efficiency.
• Provided technical support on escalated system function issues via structured escalation ticketing, maintaining KPI targets across quality and productivity metrics.
• Collaborated with cross-functional fraud detection and compliance teams to investigate and resolve high-risk customer cases, preventing financial losses.
• Conducted data analysis to identify account discrepancies, unauthorized activities, and irregularities; flagged accounts to the suspicious activity queue per compliance protocols.

Process Associate - Vibrant Screens Pvt. Ltd.

(2019-06 - 2020-03)

• Acted as Subject Matter Expert (SME) for team performance management and customer support operations in a high-volume environment.
• Mapped client requirements, identified process improvement areas, and implemented measures to maximize operational productivity.
• Delivered job-specific training to new hires, ensuring smooth onboarding and role transition.
• Resolved 90% of Level 1 customer issues independently without escalation to Level 2 coordinators.

Bachelor of Business Administration - BBA - CMR Institute of Management Studies (2016 - 2019)

Pre-University Degree - PUC - CMR National PU College (2014 - 2016)