AAKASH MISHRA

Possess strong analytical & organizational capabilities with a flexible & detail-oriented attitude, targeting
assignments in Insurance operations (Underwriting & Claims) with an organization of repute

Ph: +91 9999606336 Email: aakashmishra6336@gmail.com

Profile Summary

 A goal-oriented professional offering over7 years of experience in Insurance Underwriting and Claim Processing
 Extensive experience in Underwriting, Policy Servicing and Claims Processing activities of Health, Property, Motor and
General Insurance; proficient in managing all aspects of insurance underwriting operations, policies and procedures
 Highly skilled in managing back-end operations involving identification of loopholes and implementation of processes
 Capability in assessing risks, collecting information, preparing quotes, sharing risks with reinsurers, writing policies, and
updating records; preparing reports, presentations, underwriting manuals and other related documents as needed
 Expertise in management of claims, right from the stage of appointment of surveyor till dispatch of claim cheques including
following-up with the claims departments & surveyors for faster settlement
 Customer-centric professional; skills in building & maintaining healthy relationships with key accounts, promptly resolving
client’s queries, leading to improved customer satisfaction, repeat & referral business
 Skilled in preventing future suspicious transactions from occurring and communicating with internal & external members to
resolve disputes involving potentially fraudulent claims
 Insightful knowledge of CPT’S, Diagnosis and ICD 10
 Proven success in managing all customer service related issues and promptly resolving customers’ queries

Core Competencies

Insurance Underwriting Claims Processing Report Management

Process Improvement Operations Management Client Relationship Management
Statutory & Regulatory Compliance Risk Management Training & Development

Work Experience

Dec-18-2020-Present: Currently working with Genpact India private limited as a Management Trainee.
 Working on claims Adjudication LOB and Mainly handling claims for billed by the Member.
 Working on Claims products like Disability claims, Wellness claims, Accident claims.
 Apart from handling claims core work is no auditing these claims processed by the team members.
 Handling Team count of 10 members.
 Taking Shadow calls from clients on Regularly for queries discussion, Error Rebuttal Charged by Onshore and Daily process
Updates.
 Handling Inventory Allocation.
 Addressing calls from Audit Team for rebuttals; taking shadow call with client and AM; resolving queries of FTs
 Preparing SOPs and managing calls with onshore team
 Taking Refresher session Weekly.

Nov’17-11 Dec 2020: Optum Global Solutions Pvt. Ltd. (United Health Group), Gurugram as Senior Claims Associate
Key Result Areas:
 Worked on HD (High Dollar) claims and managing critical work types like PAR, Non-PAR, DME and Infusion
 Performed Claims Management processes like Authorization, Adjudication, Verification, Audit and so on
 Maintaining appropriate records/documents under specified security control, and providing the data to Regional & Head
office for preparation of a qualitative MIS
 Assessing, approving and denying various medical claim requests received; computing all medical benefits due and assisting
with payment initiations
 Process claims that route out of automatic adjudication, within current turnaround standards
  Creating and maintaining development of business cases for proposed service area expansions/reductions or other plan
changes by working in partnership with the Medicare LOBs to understand the requirements, timelines and processes
 Monitoring error rate & conducting write-off analysis and segmenting customer profiles into high-risk profiles
 Providing trainings in Health Insurance to the new recruits at the regional training centre; arranging for training on various
risk and claims data information systems; taking error sessions for team on regular basis
 Coordinating insurance renewal activities for client accounts, including information gathering, analysing quotes, preparing
coverage summaries, checking policies for accuracy & completeness
 Supervising claim procedures involving validity assessment and approvals of high value insurance proposals as per regulatory
requirements; offering policy administration & underwriting service to existing clients
 Managing Inventory Allocation on the production tool for the team
 Addressing calls from Audit Team for rebuttals; taking shadow call with client and AM; resolving queries of FTs
 Creating PKT (Process Knowledge Test) for team every month
 Preparing SOPs and managing calls with onshore team

Highlight:
 Delivered training to 2 batches (49 people) from Hyderabad on WebEx Platform; provided process training to both the
batches
 Promoted from Grade 23 Level 1 to 23 Level 2 within a span of 1 year
 Recognized as Top Performer and Top Rater of the team
 Worked as an internal auditor for the team for 6 months

Dec’16-Oct’17: R1 RCM, Gurugram as Senior Analyst (AR Profile)- Insurance Department (Underwriting and Actuarial)
Key Result Areas:
 Determined medical necessity for post payment denials; analyzed root cause of denials
 Designed, tested and administered policies to minimize risk and maximize the profitability of insurance policies; produced
charts and other exhibits to explain proposals & calculations
 Explained proposals and findings to various parties from company executives to clients

Nov’15-Dec’16: Xceedance InfoTech Pvt. Ltd., Noida as Analyst-Underwriting Department

Key Result Areas:
 Assessed corporate and individual financial statements for acceptability
 Investigated comparable properties to identify competitive amenities and sale prices
 Managed pricing of Motor and General Liability Insurance
 Worked on:
 Excel; used VLOOKUP, Pivot and Basic Excel
 Main LOB that is casualty which includes two LOB‘s (Auto Liability and General Liability Insurance)

Jun’14-Oct’15: Genpact India–Faculty & Content Writing, Gurugram as Process Associate

Key Result Areas:
 Worked in Underwriting Department in re-insurance process
 Directed the workflow of underwriting transactions and claims processing while meeting quality standards and compliance
with government & company regulations
 Offered prompt claims, policy administration & underwriting service to existing clients of the organization
 Operated on software’s like Wire, GFS (Global facultative system), LOCSET (Location set) and COP (Costing platform)
 Interacted directly with the underwriter on call as well as skype
 Managed LOB (Line of business)-property and worked on casualty (only submissions part)

Technical Skill

MS Office Cloud Computing (VMware)

 Education

 2015: MBA in (International Business) from Bhartiya Vidyapeeth University, Delhi

 2011: BBA from Maharishi Dayanand University (MDU), Rohtak
 2008: 12th from St. Mary’s Senior Secondary School, Delhi, CBSE
 2006: 10th from St. Mary’s Senior Secondary School, Delhi, CBSE

Personal Details

Date of Birth: 3 Nov 1990

Languages Known: English and Hindi
Address: 95-B, Rajendra Park, Nangloi, New Delhi-110041