Shraddha Kale

B.Pharm graduate with mediclaim processing and health insurance operations expertise

Talent

IndoreMember since May 28, 2026

Mediclaim ProcessingPre-AuthorizationICD-10 Medical CodingRCM (Revenue Cycle Management)Medical BillingAR Follow-upClaim AdjudicationTPA OperationsBRE ValidationPharmacovigilanceClinical Data ManagementMS Office Suite (Word, Excel, PowerPoint)TPA Claim PortalsHealth Insurance Management SystemsDocument VerificationOCR-Based Data ReviewTeam CoordinationAttention to DetailQuick LearnerCommunicationMultitaskingProblem-SolvingRevenue Cycle Management (RCM)

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Mediclaim ProcessingPre-AuthorizationICD-10 Medical CodingRCM (Revenue Cycle Management)Medical Billing

About

B.Pharm graduate with 8 months of hands-on experience in mediclaim processing and health insurance operations at BimaGarage Pvt. Ltd. Skilled in pre-authorization processing, ICD-10 medical coding, Revenue Cycle Management (RCM), and TPA claim workflows.

Certified in Pharmacovigilance, Clinical Research, Medical Billing, and AR management. Adept at coordinating between hospitals, insurance companies, and TPAs to ensure accurate and timely claim adjudication. Seeking to leverage pharmaceutical knowledge and insurance domain expertise in a clinical operations or health insurance role.

Experience

Mediclaim Processing Executive - BimaGarage Pvt. Ltd. - Pune, Maharashtra

(2025-10 - 2026-05)

Processed and reviewed pre-authorization (pre-auth) requests for cashless and reimbursement health insurance claims across multiple TPA portals.
Applied ICD-10 medical coding standards to map diagnoses with appropriate procedure codes, ensuring compliance with insurer guidelines.
Performed BRE (Business Rule Engine) validation and scrutiny of claim documents including discharge summaries, investigation reports, and prescriptions.
Coordinated with hospital billing departments and insurance companies to resolve claim discrepancies, reducing processing delays.
Reviewed KYP (Know Your Patient) documentation, verified policy eligibility, and flagged fraudulent or non-payable claims for further scrutiny.
Maintained accurate records of claim status, pre-auth approvals/rejections, and escalations in internal tracking systems.
Supported quality checks on OCR-extracted data from scanned medical documents, improving data accuracy in the claims management platform.
Processed 50+ claims per week with high accuracy, contributing to faster turnaround times for cashless settlement.