Health Care Insurance
Resume:
RAMA LAKSHMI.D
Poolankinar(PO)
Udumalpet, Tirupur- 642122
Mob: +91-965*******
Email: **************@*****.***
Objectives:
To work in a healthy, innovative and challenging environment extracting the best out of me, which is conducive to learn and grow at professional as well as personal level thereby directing my future endeavors as an asset to the organization.
Professional Experience:
Company : DELL international services, Coimbatore.
Designation : HC & Insurance Ops Sr.Rep.
Period : September 1st 2014to till date.
Job Profile : Claims Adjudication.
CLAIMS ADJUDICATION:
Description:
Claims Adjudication pertains validating the Health Care Insurance Claims from Leading Third party Insurance Company in United States. Adjudication project involves learning and processing the Concepts in US Health Care Industry.
Adjudicate the Healthcare claims from Leading Third party Insurance Company in US.
Accessing the Member’s and Provider’s Database.
Validating the Member’s History for Eligibility in terms of Name, Age, Dollar Limit,
Lifetime Maximum, and other specific Benefits with respect to the Plan the member has chosen processes claims received by the Customer.
Validating the Claim’s Provider/Physician history and details.
Validating the Diagnosis code & CPT codes and the Billed amount.
Will now publish weekly inputs along with trends on CU, PI & Internal Quality scores
Update all documents onto the respective portals
If all details are correct & perfect then Approve/Paid the claim and send it to the Accounts Department.
If any discrepancies are found in the claim then reject the claim by the appropriate reasons and send it back to the Physician.
To ensure and timely and accurate processing of member’s claims.
PROVIDER SERVICE:
Provider Errors-HRI :
In Provider Errors we will search the Providers. If individual found means we can associate with the respective TIN.
If Providers is unavailable we route those claims to Provider Builds. They will create the Providers and associate.
In Provider Errors we will assist HRI client only.
Provider Errors-PGG :
In Provider Errors PGG we will search the Providers.If individual found means we can associate with the respective TIN.
If Providers is unavailable we route those claims to Provider Builds. They will create the Providers and associate.
In Provider Errors PGG we will assist HRI and TPA clients.
Provider Builds :
In Provider Build we will create the Providers those who not available in Provider error.
We will create only Non-Contracted Provider as per client request.
In Provider Build we will assist with HRI and TPA(Third Party) i.e., HRI, 700,525,975,575 etc,
Educations:
2011-2014 BSC(CS)with 77 % Marks
Vidyasagar college of Arts and Science,Udumalpet.
2011 H.S.C with 68% Marks
Premier Mills Higher Secondary School,Udumalpet.
2009 S.S.L.C with 75% Marks
Holy Angels Higher Secondary School,Madurai.
INTER PERSONAL SKILLS:
I believe that the following positive drives would fetch me for a rewarding career
Self-confidence and Positive Attitude
Team playing
Fast learning
Personal Details
Age and Date of Birth : 22, 29-04-1994
Fathers Name : Dharmalingam.R
Sex : Female
Marital Status : Single
Nationality : Indian
Languages Known : English, Tamil
Declaration
I hereby declare that all the information furnished above is true to best of my knowledge and belief
Place: Coimbatore yours sincerely,
Date :
(D.RAMA LAKSHMI)
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