Vijay Jadhav

Associate Consultant

Hyderabad, Telangana, India3 yrs 3 mos experience
Highly Stable

Key Highlights

  • 3+ years in US Healthcare Appeals and Claims
  • Strong analytical and operational skills
  • Proven track record in regulatory compliance
Stackforce AI infers this person is a Healthcare Operations Specialist with expertise in Appeals and Claims Management.

Contact

Skills

Core Skills

Claims ProcessingRegulatory Compliance

Other Skills

Appeals ManagementAnalytical SkillsGlobal OptimizationComplaint ManagementMedical Claims ProcessingHealth InsuranceEnglishFinanceGrievancesMicrosoft ExcelOn-call SupportCustomer ServiceCommunicationB2CAppeals

About

High energetic self motivated professional with 3+ years of experience in Appeals and Claims process within the US Healthcare sector, where I’ve developed strong analytical, operational and coordination skills. Appeals Associate role is to analyzes and processes appeals, often in healthcare by researching issues, communicating with relevant parties like insurance companies or providers, and ensuring documentation and compliance. They work to resolve denied claims or other grievances by gathering information, making outreach calls, and preparing documentation for submission. I’m confident my background in healthcare operations and process management can add value to your team. Please feel free to reach out if there are suitable openings that align with my profile.

Experience

Optum

Associate

Present

Optum global solutions

Appeals Coordinator

Sep 2021Dec 2024 · 3 yrs 3 mos

  • Health insurance company specializing in appeals and grievances
  • Managed and processed appeals and grievances in health insurance, ensuring compliance with regulatory standards
  • Conducted analysis and resolution of appeals submitted by members and providers
  • Handled escalated cases, analyzing complex claim denials independently
  • Processed Good Cause cases with a focus on documentation review and regulatory compliance
Appeals ManagementRegulatory ComplianceClaims ProcessingAnalytical Skills

Star health insurance

Caller

Jun 2021Aug 2021 · 2 mos

  • Health insurance company specializing in customer service
  • Provided customer service support as an In-Bond Calling Executive

Education

Methodist College

Master of Business Administration

Jul 2020Jun 2022

Avanthi degree and pg college

B.COM (Computers)

Jul 2017Jun 2020

Pranathi junior college

XII

Jul 2015Jun 2017

Vidya sree high school

X

Jun 2015Present

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