Insurance Project

ANTHONY RAJ H E-Mail ID: **************@*****.*** +918*********

Carrier Objective:

To engage in a challenging environment with a desire to utilize my skills and to achieve the organization.

Organization: SourceHOV Services (Chennai)

Organization: Dell Business Process Solutions India Private Ltd (Chennai)

Designation: Senior Processor

Training Programs Attended:

Course

Conducted By

Period

Duration

BSC (I&B)

Source HOV

October’11

1 Month

HMS

Source HOV

January’14

15 Days

BCBS (GAR)

Dell

December

15 Days

Previous Project (Client) Details: (October’11 to January’14)

Client

Blue Shield of California (BSC I&B)

Project Description

Enroll, maintain & cancellation of new & existing members/groups request

On health plan’s offered.

Span

2.3 Years

Work Profile:

Working closely with the Insurance Company BSC (California) Using FACETS, RTMS &AS400 applications for Group Maintenance team. The processor will build the requested plan with the help of reference materials which is list out on the online module.

US based health care industry profiles on insurance sector on the projects of installation & billing (I&B) and Medicare supplementary processing. Enrolling & Billing US applicant groups into blue shield insurance company offered plans like Medicare, Medicaid & standalone plans based on the group/other department’s request.

We have to create the contract for groups. It has renewal for yearly a time. It has small group renewal and large group renewal. Small group renewal coverage for 0-2 employee’s only, large group renewal coverage for 51+ employees.

Also profiled in client training form USA for above mentioned project & certified by BSC quality team in terms of production & audits.

Roles & Responsibility:

Working closely with Group Maintenance to ensure all fields are correctly, once made by the processor will submit changes for secondary level of review. Once the walkthrough & inspections has been completed with necessary documents and the group can be released and it can submit into next level.

Previous Project (Client) Details: (January’14 to May’15)

Client

Health Management System (HMS)

Project Description

Payment posting on Mismatch and Unmatched amount send matched

amount

Span

1.4 Years

Work Profile:

Working closely with the Insurance Company of HMS (Health Management System) using HMS Medicare portal payment posting on subscriber, unmatched and mismatched amount highlighted on yellow colour we check use HMS calculator posting the payment correctly its means colour will be changed on green colour.

HMS (Medicare) follows some rules member should be above 65,member taken part A and B

Free of cost part C, Insurance covered only subscriber.

Roles & Responsibility:

Working closely with HMS team posting the payment correctly send for the member and review audit the process, invoice taken from each group month starting using with excel and then mail notification send to onshore team in particular group error has been posted.

Designation: Internal Quality Audit (HC Insurance Ops. Senior Representative) Previous Project (Client) Details: (December’16 to Feburary’17)

Client

Blue Cross Blue Shield RI (BCBSRI GAR)

Project Description

Enroll, maintain & cancellation of new & existing members request

On health, dental and vision plan’s offered.

Span

1.2 Years

Work Profile:

Working closely with the Insurance Company BCBSRI (Rhode Island) Using BLUELYNCS, MACESS, GUI, FACETS and PTERM, applications for member maintenance. The processor will add, cancel and term the member and dependents.

We follow some of rules enroll the member, Subscriber met the probationary period within group retro-active period of Qualifying Event.

We follow some of rules term the member, Subscriber should term only group retro-active period, without retro-active period means need exceptions letter

Groups are two types PER and IER PER means 0-50 employees IER means 51+ employees

Roles and Responsibilities:

Subject Matter Expert for GAR (Group Activity Report), DHP & HIPPA 834.

Audit the Claims & Charge Errors if some corrections has to be done.

Used to Mail On-shore Team to clarify their needs in Daily basis.

Used to attend Webinars & On-Shore Calls for Knowledge Transition Works.

To Enrollee the various members in BCBSRI-Blue shield Blue Cross of Rhode Island.

My Strength:

Quick learner of business processes and new technologies

Versatile and easily adaptable to work on any environment

Positive attitude, confidence and ability to widths and pressure

Good communication skills, Self-starter and highly motivated

Education:

Academic Skills:

Course & Year

Specialization

Institution

Credits

Diploma in computer Technology (2008-2011)

OS,C Programming, Java, .Net, RDBMS, etc.

Jaya Polytechnic College, Thiruninravur, Chennai.

Completed

HSC (2008)

Maths, Physics,

Chemistry&

Biology

Singram Pillai Higher Secondary School, Villivakkam, Chennai.

Incompleted

SSLC (2006)

State Board

Singram Pillai Higher Secondary School, Villivakkam, Chennai.

Completed

Personal Profile:

Name : Anthony Raj H

Father’s Name : : Hiruthaya Swamy A

Sex : Male

Marital Status : Married

Nationality : Indian

Religion : Christian

Date of Birth : 16.01.1990

Hobbies : Listening Music, Playing Indoor & Outdoor Games.

Language know : English, Tamil

Address : No: 7/239 Sidco Nagar 55th St, Villivakkam, Chennai 600049.

DECLARATION:

I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility for the correctness of the above mentioned particulars.

Place: Chennai Yours Faithfully,

Date: (H.Anthony Raj)

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