Sharada Kamble

A dedicated and skilled professional with extensive experience in U.S. Healthcare claims processing and back-office operations. Skilled in adjudicating, analysing, and resolving complex medical claims with accuracy and compliance to HIPAA regulations. Proven expertise in working with claims lifecycle, including eligibility verification, benefit determination, coordination of benefits, denials management, and appeals.

Sr. Representative Operation (Healthcare Claim Adjudication) - Concentrix Daksh India Pvt. LTD - Pune

(2024-12)

• PROCESSED CLAIMS IN ALIGNMENT WITH U.S. HEALTHCARE GUIDELINES.
• ADDRESSED AND RESOLVED HEALTH PLAN BENEFIT, PROVIDER, PRICING, AND SYSTEM ISSUES
• ADJUDICATED CLAIMS TO MAINTAIN SERVICE LEVEL AGREEMENTS.
• PROCESSED VARIOUS CLAIMS, INCLUDING UB04/HCFA1500 INPATIENT/OUTPATIENT, HIGH DOLLAR AND BLUE CARD CLAIMS
• PREPARED AND DISSEMINATED CLIENT-LEVEL REPORTS, INCLUDING WORKFLOW STRATEGY, PRODUCTION SUMMERY, AND TAT REPORTS.
• REQUESTED ANY NEEDED DOCUMENTATION FOR BILL PAYMENT.
• ENSURED ACCURATE DETERMINATION OF ELIGIBILITY, BENEFITS, AND PROVIDER CONTRACTS BEFORE ADJUDICATION.
• PERFORMED QUALITY AUDITS ON CLAIMS TO MAINTAIN ACCURACY, COMPLIANCE, AND SERVICE LEVEL AGREEMENTS (SLAS).
• PROVIDED TRAINING, MENTORING, AND SUPPORT TO JUNIOR REPRESENTATIVES TO IMPROVE TEAM PERFORMANCE.
• Participated in blood donation camp at Shivanand College Kagwad.
• Contributed to social responsibility activities in Concentrix Daksh.
• Participated in CSR Activities in Concentrix Daksh
• Shared innovative ideas for process improvement and time reduction in Concentrix Daksh.

B.com - Shivanand College Kagwad (2023)

PUC - Sarvepalli Radhakrishnan PU college Ingali (2020)

SSLC - Murarji Desai Residential School, kudachi (2017)