Jay Shankar Pandey

Detail-oriented and analytical professional with experience in medical claim processing, back-office operations, Freight billing analysis, and data management. Skilled in reviewing medical insurance claims, verifying policy coverage, handling reimbursement and cashless claims, and coordinating with hospitals, TPAs, and insurance providers. Strong knowledge of MS Excel, reporting, data accuracy, and operational coordination with the ability to manage high-volume workloads while maintaining compliance and process efficiency.

MEDICAL CLAIM ASSOCIATE - DATA SOLUTIONS INDIA PVT LTD.

Healthcare Operations

• Processed and reviewed medical insurance claims accurately within defined turnaround timelines.
• Verified patient eligibility, policy coverage, and medical documentation for claim approval and settlement processing.
• Reviewed claims for coding accuracy and compliance with healthcare insurance guidelines and company policies.
• Coordinated with hospitals, patients, TPAs, and insurance providers for claim clarification and issue resolution.
• Managed cashless hospitalization and reimbursement claim processes efficiently.
• Investigated and resolved claim discrepancies, denials, pending cases, and documentation-related issues.
• Maintained accurate records of claim status, approvals, rejections, and settlements.
• Prepared MIS reports related to claim processing, settlements, and pending cases.
• Communicated claim updates professionally through email and phone support.
• Supported internal audits and quality checks to ensure process accuracy and compliance.

DATA ANALYST (BILLER) - ARDEM DATA SERVICES PVT. LTD. - Lucknow

(2019-07 - 2025-03)

• Managed high-volume logistics and billing data with 99%+ accuracy.
• Processed an average of 200 freight bills daily while coordinating with operational teams.
• Generated shipment tracking, inventory, and delivery performance reports.
• Identified and resolved data inconsistencies to improve operational efficiency.
• Collaborated with teams to streamline processes and improve workflow productivity.
• Maintained vendor and customer database records accurately.

PRICE POLLING EXECUTIVE - CMIE PVT. LTD. - Lucknow

(2016-08 - 2019-06)

• Generated daily spot-price reports for major commodity markets across India.
• Maintained voice backups and audit documentation for operational reporting.
• Coordinated with traders and market participants to collect pricing information.
• Documented local market trends, taxes, delivery methods, and pricing factors.

Masters of Business Administration - MBA - Sacred Heart Institute of Management and Technology (2016)

Bachelor of Business Administration - BBA - Sacred Heart Degree College (2014)

Intermediate - GSS Niketan Inter College (2010)