SHEJAL HANMANT GARUD

U.S. Healthcare Claims Associate / Analyst

• Managed end-to-end backend processing of U.S. healthcare insurance claims, ensuring operational accuracy, financial alignment, and smooth claim resolution within defined timelines.
• Reviewed, analyzed, and updated prescription claim data through Citrix, validating drug information, quantity, refill status, and financial values while maintaining compliance with policy guidelines and audit standards.
• Updated patient drug and dosage details in accordance with insurance eligibility, plan restrictions, and prescription limits; verified NDC codes and dosage calculations to minimize claim denials and improve processing accuracy.
• Supported finance and accounting teams by reconciling claim-related data, resolving mismatches, validating processed vs. approved amounts, and contributing to accurate billing, payment posting, and financial records.
• Ensured strict compliance with HIPAA regulations and data privacy guidelines while maintaining data accuracy; collaborated with cross-functional teams to resolve discrepancies, improve workflows, and streamline claim operations.