Claims Specialist
GBG services Pvt Ltd
Total years of experience :10 years, 3 Months
We received all types of claims like (HCFA, UB, Directs, Member, provider, Dental & Vision Claims, travel Claims.
Handle all phases of a claim, including gathering reports, investigating, and correcting any issues, collecting payments, determining coverage, and closing files.
Scrutinizing Medical Claims documents and settlements.
Allocation of Inventory to the team, this task involves the strategic distribution of available inventory to meet demand while optimizing resources.
Preparing Weekly summary report of the team on production, quality and performance metrics.
Managing and coordinating training programs and giving feedback to the team.
Coordinating with cross-functional teams to align allocation decisions with broader business objectives.
Coordinating with IT team on the EDI fallouts.
Managing and coordinating training programs.
Ensuring that the key service level agreements are met consistently without any exceptions for providers who are out of network and have direct billing agreement with the company.
Work on denial management of claims and ensure accurate information has been provided.
Enter claim payments, and new claims on a computer system, inputting concise yet complete sufficient file documentation.
Worked on Avantys Health insurance. Avantys is a new generation of insurance company specializing in the design and management of international health insurance plans for individuals and businesses.
Completion of cases in queue within specified time frame with Meeting Quality scores.
Work on Non claims with eye for detail & logical thinking.
Provider/facility update, verification, and corrections.
Process all procedure types like (Home health, DME, Therapies, Medical, Surgical…etc.)
Dealing with Outpatient/Inpatient claims and work on HCFA/UB and Non claims.
Doing quality audits and work assigning to the team.
Maintaining all reports (EOD, Daily count sheet, Snapshots) behalf of temp SME
Call with onshore team and clarify team queries.
Processed incoming Medicare claims in a timely manner while meeting quality guidelines.
Maintained knowledge of policies and procedures for processing claims on a daily basis.
Worked with team members to ensure consistency among all staff in procedures used.
Worked with trainers, mentors, and managers on streamlining processes when areas for growth are identified, It involves Entry, Quality Checking and Random Checking.
Provider/facility update, verification, and corrections
Handling Validation process and give complete information on life insurance policies customer opted for.
Provide information on policies and related issues over the phone, ensuring accurate information is provided, and compliance with protocols.
Documenting customer interactions, issues, and resolutions in the company's CRM system.
Finding solutions to problems and escalating issues when necessary.
Providing feedback to management for process improvements.
Managing time effectively to handle multiple customer inquiries and tasks simultaneously.
➢ MBA (FINANCE) From JNTU-H in 2012 with 65%.
➢ B.Com from Osmania University in 2010 with 58%.
➢ Intermediate with (C.E.C) from International Junior College in 2007 with 55%.
➢ S.S.C. from Priyadarshani High School in 2005 with 64%.