Open to opportunities

Naveen Nayak

@naveennayak

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Process consultant specializing in US healthcare claims processing and adjudication.

India

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What I'm looking for

I’m looking for a US healthcare role where I can apply my medical terminology, claims processing, and adjudication skills with utmost accuracy, integrity, and professionalism—while working to ensure compliance, resolve denials, and improve customer satisfaction.

I’m a Process Consultant with hands-on experience in optimizing insurance claim processes in the US healthcare domain. In my current role, I process and adjudicate healthcare claims with accuracy and timeliness while following payer policies and guidelines.

I’m confident interpreting CPT, HCPCS, ICD, and procedure codes to validate medical necessity and determine coverage. I also review healthcare documentation to ensure correct reimbursement, perform eligibility verification, and apply HIPAA-compliant practices in a fast-paced, high-accuracy BPO environment.

I take ownership of the full claims lifecycle, including benefit determination and denial resolution. I coordinate with insurance providers and hospitals to resolve claim-related queries, and I collaborate with audit and quality teams to ensure medical accuracy and compliance.

Experience

Work history, roles, and key accomplishments

Process Consultant

Sagility Ind Pvt Ltd

Jul 2024 - Present (1 year 11 months)

Processed and adjudicated healthcare insurance claims in compliance with payer policies and guidelines, ensuring accurate and timely reimbursement. Interpreted CPT, HCPCS, and ICD codes for medical necessity and coverage, and supported eligibility verification and denial resolution.