راشد Azhakankandathil

 Preparing DBA (Direct Billing Advise) for the network providers as per the policy terms and conditions.
 Handling all Hospital Approval cases.
 Register the claims in system as master registration for month wise.
 Processing of submitted invoices as per the guidelines of medical claims.
 Maintaining updated list of network providers as per the CCHI notifications.
 Auditing all the reimbursement claims by policy-wise.
 Settlement of all classes of claims in accordance to the Policy's terms, conditions and Loss Adjusters' Final Reports.
 Monthly Portfolio analyzing reports each month.
 Ensuring that customer requirements are determined and fulfilled.
 Initiate customer feedback exercises and provide feedback to the management.
 MIS Reports to the management.
 Analyze claims to determine extent of company's liability, make approval or denial decisions and negotiate settlements with claimants in accordance with policy provisions.
 Collaborate with insurance agents and interview claimants to correct errors, rectify omissions and investigate questionable issues.

Claim processing excecutive

Efficiency In Functions Handled



•Ability to handle all types of claims including multinational cases.
•Customer care skills with a positive attitude.
•Supervising the subordinate staffs defining their duties and responsibilities.



KEY SKILLS

•Claims Handling and Investigations
•Evaluation of Liability in terms of user
•Preparation of Claims Reports and proper Documentation
•Policy Interpretation
•Confidential Records Management
•Validation of claims
Outcomes:
•Accompanied underwriters and insurance agents in the field to investigate claims and determine cause and extent of cases.
•Uncovered fraudulent claims scheme; provided evidence leading to the recovery in insurance overpayments.
•Developed a strong understanding of insurance policies and legal issues through completion of a series of INS classes coupled with in-depth, multi-week claims training