Deepsikha Pradhan

Dedicated and detail-oriented Executive Clinical Professional with extensive experience in claims analysis and healthcare processes. Proven track record of effective cross-team collaboration and the application of clinical judgment to ensure compliance with regulatory standards. Skilled in managing a diverse range of claims, including No Fault, Medicare, Medicaid and Commercial insurance, with a strong focus on accuracy and efficiency.

Committed to optimizing processes and enhancing outcomes in the healthcare industry.

EXECUTIVE CLINICAL- US HEALTHCARE - SAGILITY INDIA - BANGALORE

(2023-09 - 2025-06)

• Conduct comprehensive claim analysis, processing and adjudication while ensuring strict compliance with regulatory standards.
• Collaborate effectively with cross-functional teams, including Finance to streamline operations and enhance documentation practices using advanced Excel functionalities.
• Review medical records meticulously, adhering to rigorous protocols to assess patient eligibility for insurance reimbursement.
• Perform clinical reviews to evaluate medical necessity for identified claims, applying extensive clinical judgment acquired through years of experience in acute care settings.
• Validate all information related to claims, ensuring accuracy and integrity throughout the review process.
• Maintain compliance with procedures and regulations for medical record management.
• Engage continuously with various departments to direct activities toward positive outcomes.
• Proficient in managing No Fault claims, Medicare, Medicaid and Commercial insurance claims, demonstrating a versatile approach to complex claim scenarios.

JUNIOR STAFF NURSE - ASIAN INSTITUTE OF GASTROENTEROLOGY HOSPITAL (AIG)

(2022-03 - 2023-07)

• Monitored patient’s health in IP Ward, recording medical histories and symptoms for accurate documentation.
• Collaborated with healthcare teams to deliver comprehensive patient care.
• Operated medical equipment and supported clinical procedures.

B.SC Nursing - Rajiv Gandhi University Of Health Science, Karnataka (2022)

H.S.C - West Bengal Council Of Higher Secondary Education, Kolkata (2017)

S.S.C - West Board Of Secondary Education, Kolkata (2014)