Mohammed Mujtaba Ali

Processing direct / reimbursement, paper claims / automated / electronic / scanned claims.
* Properly encode, evaluate and process more complex and high cost outpatient and inpatient
network claims, reimbursement claims, resubmission claims, and reconciliation of claims.
* Managing claim from processing level to settlements.
* Responding brokers, clients through email and calls.
* Issuing member utilization report to brokers as per request.
* Issuing credit & debit note through oracle system
* Maintain Operational Reports for work consistently and punctually on weekly, Quarterly &
Monthly.
* Assisting Manager for Preparing Loss Ratio Report.
* Calling providers and clients for fraud Optical/dental claims.
* Coordinating with roving doctors to ensure claims occurred.
* Report fraud and abuse cases to Medical Investigation and Audit Department according to
set policies and procedures.
* Monthly Reconciliation Bank Statements with Our records
ACCOUNTS EXECUTIVE (CLAIMS) AT FOCUS HEALTH CARE COMPANY (FEB 2015-JULY 2017)
* Take care of all finance related activities.
* Co-ordinate with Claim Processing Executives with respect to claim disbursements
* To process claims according to work instructions laid down in documented procedure.
* To maintain records in accordance with ISO 9001-2000 requirements
* Take necessary corrective action & preventive required to reaching departmental objectives.
* Report statistical data on a weekly basis to Team Leader.
* To ensure the quality of claim processing
* Ensure proper documentation of all incoming and outgoing claim documents/files.
DECLARATION