Ritik Chauhan

Detail-oriented Appeals Representative Associate with a Bachelor of Business Administration and hands-on experience in healthcare revenue cycle management. Proven expertise in claim adjudication, researching and resolving complex claim denials, and ensuring strict adherence to regulatory guidelines. Strong technical foundation in data management and advanced Excel, combined with a fast-learning mindset.

Skilled at working independently and collaborating cross-functionally to recover revenue and support business objectives.

Appeals Representative Associate at Optum (2025-01 – Present)

• Investigate and resolve complex claim denials by thoroughly reviewing Explanations of Benefits (EOBs), medical records, and payer-specific coding policies.
• Draft and submit comprehensive, evidence-based appeal letters to commercial and government insurance companies, successfully overturning denied claims.
• Identify recurring denial trends and escalate root-cause issues to management to help prevent future revenue leakage.
• Communicate with healthcare providers, insurance representatives, and internal teams to gather required clinical documentation and drive faster claim resolution.
• Maintain strict compliance with healthcare regulations and adhere to timely filing limits across multi-level appeals.

Bachelor of Business Administration in BBA – Lloyd Business School (2023)

Intermediate in CBSE – Nutan Marathi Senior Secondary School (2020)

Matriculation in CBSE – Brahmananda Public School (2018)