Ritesh Gaikwad

2+ years of experience in Claims Process. Work experience in Optum Global Solutions. Strong knowledge in Claims Process.

Responsibilities solving reviews & adjustments.

Experience working in rotational shifts. Have the motivation to take independent responsibility as well as ability to contribute and be a productive team member. Possess excellent interpersonal and communication skills.

Claims associate - Optum global solutions pvt ltd

(2024-05-02)

• Processing all CPW Hospital Work type UB-04 claims as per guidelines
• Verifying the Member, Patient and Provider details as submitted
• Keen understanding the Process Updates regularly.
• Achieving the Quality Goals month on month.
• At most concentration on processing claims to sustain 100% Accuracy.
• Working in PI (Payment Integrity) span under CCM(Claim Cost Management).
• Understanding the Business requirement as and when required.
• Quick learning with strong planning, ability to work independently or in a team and Strong interpersonal and analytical skills.
• Managing the Inventory as per the business needs meeting the productivity goals with 100% Quality.
• Managing and controlling reports & closing the issues before TAT.
• Attending Onshore calls for process queries, share point issues and resolutions.

MBA - Osmania University (2026)

B.com - Computers - St.Frances degree College (2023)

Intermediate - Narayan Junior college, Narayanguda (2020)

Secondary school - Indra Vidya Niketan school, Lal darwaja (2018)