Shaivya Rai

To work in a challenging position in the US Healthcare sector where I can utilize my claims processing experience, analytical ability, communication skills and attention to detail, while contributing to the organization and developing my professional skills.

Claims Associate - Wellcove by CHCS Services

(2025-02)

• Process US Health Insurance claims for multiple payers under Accident LOB and Hospital LOB.
• Investigate medical and accident-related claims and verify coverage and eligibility as per process requirements.
• Review UB-04 forms, medical records and supporting documents for accuracy, completeness and claim processing.
• Analyze claim information to identify discrepancies, missing documents and claim-related issues.
• Coordinate with hospitals and internal teams to resolve claim issues and denials efficiently.
• Maintain process quality and productivity standards while meeting assigned production targets.
• Consistently achieved 90% quality score while maintaining 100% production target.
• Follow process guidelines and complete assigned claim transactions accurately within defined timelines.

Bachelor of Pharmacy - Pharmacy - Dr. A.P.J. Abdul Kalam Technical University (AKTU) (2024)

12th - NIOS (2019)

10th - CBSE (2017)