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abhishek kumar, claims processor

abhishek kumar

claims processor·care health insurance

India

Bachelor's degree, Pharmaceutical And Health Sciences

Work experience

Total years of experience: 1 years, 6 months

claims processor

December 2024 - Present

care health insurance

Gurgaon, India

I found this job using Bayt.com

December 2024 - Present

I’m a Health Insurance professional with a strong background in medical claim processing and policy-based analysis, supported by a B.Pharm qualification.
I have hands-on experience in medical claim scrutiny, discharge summary evaluation, treatment justification, and policy interpretation as per insurance guidelines.
My work involves analyzing hospital bills, clinical documents, diagnosis & procedures, identifying discrepancies, and ensuring accurate claim decisions in line with policy terms and regulatory standards.
I’m well-versed in medical terminology, hospitalization workflows, and insurance documentation, which helps in effective coordination between hospitals, TPAs, and internal teams.
Company industry:
Insurance & TPA
Job role:
Finance and Investment

Education

Lloyd school of pharmacy

January 2025

January 2025

Bachelor's degree, Pharmaceutical And Health Sciences

India

GPA (rating): Excellent

GPA (rating): Excellent

Medical Claim Scrutiny & Processing • Policy Terms & Conditions Interpretation • Discharge Summary & Medical Record Review • Diagnosis–Procedure Correlation • Billing & Discrepancy Identification • Hospital & TPA Coordination • Regulatory & Policy Compliance

Skills

Medical Claim Scrutiny & Processing• Policy Terms & Conditions Interpretation•
Expert
Medical Claim Scrutiny & Processing• Policy Terms & Conditions Interpretation•
Expert
Administration
Expert
Administration
Expert
Management
Expert
Management
Expert
Science
Expert
Science
Expert
Accounting
Intermediate
Accounting
Intermediate
Microsoft Excel
Expert
Microsoft Excel
Expert
Microsoft Office
Expert
Microsoft Office
Expert
Customer Service
Expert
Customer Service
Expert
Insurance Claims
Expert
Insurance Claims
Expert

Languages

English

Expert

Training and Certifications

Training
claim process reimbursement
Dec 2024
Show credentials
clinical pharmacist
Sep 2024
Show credentials

Hobbies and interests

Fitness and maintaining a healthy lifestyle

Fitness and maintaining a healthy lifestyle