Hi, I’m Vishal

Health Claim Adjuster

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My professional skills

Detail-oriented Health Claims Professional with proven expertise in EMR systems, medical records management, and claims adjudication—skilled at streamlining patient data workflows, coordinating with clinical teams, and ensuring regulatory compliance through quality-focused reporting and investigation.

Medical Records Management

Skilled in retrieving, organizing, and validating patient records to ensure accurate and secure claim processing.

Claims Adjudication & Investigation

Experienced in analyzing health, accident, and reimbursement claims using coding standards (ICD, CPT, HCPCS) to ensure compliance and prevent fraud.

EMR & Health Information Systems

Proficient in managing large-scale data migration and daily operations using EMR tools like Accuro and HL7 interfaces.

Proficient in EMR systems (Accuro, HL7), medical records management, health claims adjudication, regulatory reporting, and interdepartmental coordination to optimize healthcare workflows and ensure compliance.

Medical Records Management
95%
Claims Adjudication & Investigation
90%
EMR & Health Information Systems
88%
Report Preparation & Quality Control
85%
Patient & Practitioner Coordination
92%

Work Experience

Square Medical Clinic
Administrator Assistant
May 2024 – Present ,Canada
  • Efficiently manages EMR systems, triages patient inquiries, and coordinates schedules to enhance continuity and quality of clinical care.
  • Handles high-volume communications, updates case logs, and ensures compliance with PHIPA through secure data and email management protocols.
Queen Hanson Medical Clinic
Medical Administrative Assistant
January 2024 – March 2024 ,Ontario
  • Digitized over 2,500 charts into EMRs, optimized appointment scheduling, and reduced no-show rates through automation and team collaboration.
  • Validated insurance coverage, migrated lab reports using HL7 standards, and ensured compliance by conducting weekly health record audits.
Nivabupa Health Insurance
Claim Facilitator Representative
July 2018 – March 2023 ,India
  • Adjudicated 1,200+ claims by verifying codes and documents, ensuring accurate classification, and meeting compliance and policy standards.
  • Led audits, flagged anomalies using analytics, and coordinated anti-fraud investigations to improve accuracy and regulatory adherence.

MY Educational details

Academic foundation in healthcare leadership and homoeopathic medical sciences.

Health Care Leadership – Canadian Context

Institution: Sault College, Canada
Duration: May 2023 – December 2024

Bachelor of Homoeopathy in Medicine and Surgery (BHMS)

Institution: Lord Mahavira Homoeopathic College, India
Duration: May 2011 – November 2016

(+1) 437-799-9215
Ontario, Canada
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