Dr.

Priyanka Juneja License Number A-10565

BDS, MIDA, MBA Hospital Management

Approx. 7 + Years of experience as medical officer, India & USA Claim Process, Claims
Audit, Reimbursement & Hospital administration, and management.

Priyankaj826@gmail.com Mob: +91 8310498932, 8722988891

OBJECTIVE:
To work in a reputed organization or hospital as a Hospital Management,
Medical officer Claims Operations/Audit Process & transcriptionist.

Clinical and research skills performed during volunteer work:

➢ Attained broad knowledge in the etiology, prevention, diagnosis, and
management of oral and dental health in adults and children.
➢ Practiced pediatric oral medicine and pediatric therapeutics.
➢ Managed dental emergency clinics.
➢ Managed the restoration of traumatized teeth.
➢ Operated and assisted in day case general anesthesia sessions for
surgical impactions, extractions, and restorative treatments.

SUMMARY OF QUALIFICATIONS
➢ 04 Year Bachelor of Dental Surgery from Ch. Charan Singh University
INDIA
➢ 1 Year Internship completed from Shree Bankey Bihari Dental College
& Research Center- Sep 2011 to Oct 2012
➢ 2 Years MBA in Hospital Management from Assam downtown
University
➢ Member of Delhi Dental Council, INDIA

D r P r i y a n k a J u n e ja , B DS , M B A in H ea l t h c a r e , M I DA C e r t if i ed
Current Employer: - CHCS Former Capgemini
Aflac USA Claim Process Lead from Dec 2021 to Till June 2023
Job Responsibilities:
o Coordinating & communicating with the Aflac for processing the
claim.
o Processing of US Health Care complex claims work - Appeals &
Grievances of processed or denied claims.
o Responsible to Prioritize work and adjudicate claims as per
turnaround time.
o Responsible to involves working independently on researching,
reviewing, summarizing, and recommending a course of action on
claims where an appeal or a grievance has been filed for a denied /
under payment.
o Strong English comprehension, mathematics & medical science
knowledge to comprehend medical reports.
o Responsible to ensure claims are adjudicated as per the
client/company guidelines. Provide continual evaluation of processes
and procedures.
o Responsible to respond to and resolves claims received via emails.
o Responsible to correctly calculate claim amounts for the customers •
o Responsible to complying with company regulations regarding
HIPAA, confidentiality, and private health information.

Medical Officer at Medi Assist TPA INDIA

Approx. from Feb 2017 to Jan 2020
Previous Job
o Job Responsibilities:
o Coordinating & communicating with the subordinate for processing
the claim.
o Coordinating with CRM for details of the corporate employee &
individual insured.
o Coordinating with insurance company for specific approvals &
corporate buffer.
o Handling the grievance related to the rejection/ denial of the
Cashless request as well as re-reimbursement claims.
o Providing the Quality services by keeping the minimum TAT.
o Updating the new terms & condition of new product of the insurance
company.

D r P r i y a n k a J u n e ja , B DS , M B A in H ea l t h c a r e , M I DA C e r t if i ed
Previous Experience
09 Months Experience from 2015 March to 2015 Nov
Hospital - Fortis Hospital Bannergatha Bangalore
Role Dentist & Hospital Management

o Insurance coordination for the claim process TPA

o Responsible to process the medical claims.
o Handle Patients for dental care.
o Scaling, Polishing, bleaching teeth, tooth extraction, RCT & General
Dentistry

PROFESSIONAL HIGHLIGHTS
✓ Certified member of Delhi Dental Council.
✓ Member of the Indian Dental Association.

Personal Details
o Marital Status – Married
o DOB - 16 April 1987
o Passport No – W2350744
o Nationality – Indian
o Language Known – English, Hindi

D r P r i y a n k a J u n e ja , B DS , M B A in H ea l t h c a r e , M I DA C e r t if i ed