• Worked with Commercial claim as an Examiner with 100% production. • Handling retails and Group claim Quality, 29 spans of people currently on the floor; provide solution to all agent queries. • Independent and timely processing of claims in accordance with client requirements, member plan benefits. • Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures. • Meets quotas in terms of quantity and quality of claims processing standards. • Maintain current knowledge of assigned plan (s) and effectively apply this knowledge in the processing of claims and providing customer service. • Good analytical, Interpretation and problem solving skill • Supporting the team members in case of any doubt. • Good client interaction in terms of Escalation, Call calibration or improving areas of products. • Take a weekly call with onshore team. • Review and analyze weekly and monthly reports for the Billing depar
Achievements
• Moved into Quality Team within 5 months of Processing and handling Mumbai and Manila team and co-ordinate with the onshore team. • Raised 4 Idea’s in We @ Accenture portal for Process Improvement. • Have been recognized at team level for Quality. • Best Samaritan awards for good work. • Numerouno awards for best of month for October and September. • Successfully completed Quality auditor certification programme.
Sr.Process Associate
WIPRO PVT.LTD
Full TimeJan-2012 To May-20131 year 4 months
Responsibilities
• Analysis on denials of claims with resolutions on reprocessing claims with insurance. • Should meet the productivity targets within the stipulated time. • Ensure that the deliverables to the clients adhere to the quality standards. • Develop and maintain information about insurance denial strategies for training purposes in knowledge repository share point and claim process for and done with payment for provider and insurance. • Ensure SLA levels defined for the Billing department are met and take corrective actions as appropriate • Process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements. • Log efforts in time tracking systems on daily basis
Achievements
• Rewarded for outstanding performance in terms of production and Quality. • Awarded best processor for the queue from Clients End.
Team Coach
GEBBS HEALTHCARE SOLUTION PVT. LTD
Full TimeFeb-2007 To Mar-20114 years 1 month
Responsibilities
• Processing Health Claim for the Clients. • Quality checking for the different clients and corrected claim • Payment posting Health claim • Process high dollar claims with additional responsibilities of coordinating with team members to reach production targets and maintain quality standards in claims processing. • Effectively managed all reports of production, auditing and quality checks, error database & Preparing RCA for quality, etc. • Consistently met and exceeded the productivity, accuracy and turnaround time set by the clients. • Handling the Quality for the all team member. • Other works doing for updated MIS and quality report and maintain the quality Daily Production Report. • Daily updated the Status Reports and Cash log. Handling the Different project in payment posting.
Achievements
• Rewarded for outstanding performance in terms of production and Quality. • After 1 years promoting for trainee team coach and handling new project.
