RAHUL KUMAR MALKAJGIRI
DUBLIN
Summary
Healthcare appeals professional with experience reviewing denied and disputed medical claims, analyzing records, and applying policy and regulatory standards to reach accurate decisions. Progressed into a senior role handling complex cases, quality checks, and team guidance while coordinating with providers, members, and internal teams to resolve information gaps and keep work moving.
Overview
4
4
years of professional experience
Work History
Senior Appeals Representative
Optum Global Solutions (UNITED HEALTHCARE GROUP)
Hyderabad
01.2025 - 01.2026
- Promoted to Senior Appeals Representative for consistently high accuracy, strong case judgement, and reliable performance in complex appeal scenarios. Handled advanced and high-priority appeals, including escalations requiring deeper policy interpretation and detailed medical documentation analysis.
- Handled complex and high-priority medical claim appeals, making sure each decision was accurate, fair, and clearly supported by documentation. Reviewed medical records, claim details, and policy guidelines carefully to reach well-reasoned and compliant outcomes.
- Managed a consistently high workload, balancing speed with accuracy and maintaining turnaround times even during busy periods. Worked closely with internal teams to resolve missing information or discrepancies, helping cases move forward without unnecessary delays.
- Identified recurring workflow issues and proposed changes that led to reduced rework. Provided guidance to team members on managing complex documentation and decision-making.
- Ensured clarity in case notes and decisions for easy understanding, minimizing rework and reinforcing reliability in handling complex cases.
- Conducted quality checks on cases to maintain accuracy levels and ensure compliance with audit standards.
- Adapted to changing priorities by handling urgent or escalated cases and ensuring proper management.
Appeals Representative Associate
Optum Global Solutions (UNITED HEALTHCARE GROUP)
Hyderabad
01.2022 - 01.2025
- Processed high-volume medical claim appeals with strong accuracy and turnaround times, ensuring fair and compliant decisions across complex cases. Reviewed denied or disputed claims by analysing medical records, claim notes, coding details, and supporting documentation to determine correct outcomes.
- Enhanced appeal decision accuracy by identifying policy mismatches, coding errors, and documentation gaps prior to finalising decisions.
- Collaborated with providers, members, and internal teams to gather missing information, resolve discrepancies, and prevent processing delays. Reduced rework and repeat escalations through high-quality case reviews and clear, structured appeal summaries.
- Took ownership of complex cases, ensuring resolution with well-supported decisions. Built trust with cross-functional teams through clear updates, accurate case summaries, and timely follow-through, contributing to backlog reduction during peak periods.
- Maintained strong performance metrics across accuracy, productivity, and compliance, contributing to overall team KPIs. Built a reputation as a go-to person for detailed case analysis, reliable documentation, and consistent performance.
- Identified recurring process gaps and recommended changes that improved workflow clarity and efficiency.
Education
MSC - International Business Management
Griffith College of Ireland
Dublin, Ireland02-2026
Bachelor of Commerce - Computer Applications
Aurora Degree & P.G. College (Osmania University)
Hyderabad, India01-2022
Skills
- Claims & Appeals Processing
- Medical Records & Documentation Review
- Healthcare compliance
- Policy Interpretation
- Process improvement
- Microsoft Excel, Word, PowerPoint
- Problem Solving & Decision Making
- Stakeholder communication
Timeline
Senior Appeals Representative
Optum Global Solutions (UNITED HEALTHCARE GROUP)
01.2025 - 01.2026
Appeals Representative Associate
Optum Global Solutions (UNITED HEALTHCARE GROUP)
01.2022 - 01.2025
MSC - International Business Management
Griffith College of Ireland
Bachelor of Commerce - Computer Applications
Aurora Degree & P.G. College (Osmania University)