Professional Experience Project

D. Hari

No.R**, Pallavan Nagar

*st Main Road

Thiruverkadu, Chennai-600077

Email: *.********@*****.***

Mobile: +919*********

Objective:

To widen and employ my dexterity in the organization where I will have opportunity to contribute to the augmentation of the organization and to improve competently and personally.

Profile Summary

Claims Adjudication Process of US Healthcare Payer Industry

Possess good interpersonal, analytical, organizational knowledge and skills

Have acquired a high level of understanding of Medical and Hospital Claim processing and associated Business Areas

Professional Experience

Organization - Accenture Service Pvt. Ltd.

Domain - Health and Life Science

Designation - New Associate

Period of Working - January 21th 2014,27.Aug.2015

Roles and Responsibilities

As an adjuster, I will decide to finalize or reject the claim.

Certified processor from Well Point Inc., processing “U.S Health Care Claims” by logging through Main frame system of Citrix application and adjudication the claims in “Customer-Server”. Claim is pulled by Ultera application and processed by Facets application.

Validation the Members data in terms of Age, Lifetime Maximum, payable limits and other specific benefits with respect to the plan the member has chosen processes claims received by the Customer.

Involves accessing the Member’s and Provider’s Databases.

Validation the billed diagnosis codes, procedure codes and other details of services done to release the payment which is determined by CMS (Centers for Medicaid and Medicare Services)

Claim Types involved: Member submitted claims, MB General, Radiology, Laboratory, OOA Claims, Emergency Services, Anesthesiology Services, Inpatient and Outpatient Claims

Processing claims as per the benefits guidelines

Acquiring knowledge of related areas of the project

Identify and resolve complex process related Claims on a day-to-day basis

Understanding and adhering to quality standards

To process Facility, Professional and Member submitted Claims accurately and meet the daily targets

Actively participation in all types of discussions like scheduling tasks, daily stand up meeting, Enhancements discussions, etc.,

Completed all assigned tasks well before the end time

Educational Qualification:

2011-2013 Msw.( Community Development ) with 59% at Loyola College, Chennai.

Completed B.B.A ( Business Administration ) with 58% at Sindhi College, Chennai in the year 2008-2011

2006-2008 higher secondary level at S.K.D.J. HSS with 65%

2005-2006 Secondary level at S.K.D.J. HSS with 52%

Academic credentials and project summary:

Worked as an Internship at “Chennai port Trust” (HRM)

Worked as a trainee in an organization namely “Plant” which is working for the fisher community in Chennai.

Worked as a trainee in “Arpanam” which is working for the (self help group)

Worked as a trainee in “Thozhamai” which is working for the slum clear board in Chennai.

Personal Data:-

Father’sName:Dayalan.K

Mother’sName:Ponnamal .D

DateofBirth: 18/02/1990

Sex:Male

Religion : Hindu

Nationality:Indian

MaritalStatus:Single

Mobile: 967-***-****

Languages Known:

English

Tamil

Telugu

Software skills:

MS Office

Tally

Spss

Co-Curricular activities:

Volunteered for International conference (Social Work Dept) held in Loyola College

Volunteered for the Child development camp, conducted by PSWA.

I believe that my leadership skill is one of major strengths and that have helped me a long way in my academics and also my personal life.

I have been a part of several team works in my School and College and I strongly believe that my outcome to subject matter is much batter as a person in a team and it has helped me understand the outlook of every individual on particular issue.

References: Available on request.

I D.Hari, hereby declare that the information finished above is true to the best of my knowledge

and belief.

Place: Chennai

Date: D.Hari

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