Senior Process consultant

CURRICULUM VITAE

SWATHI.R

Phone : 996-***-****

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

Address:

W/o Kishor.M

C/o L.R. Krishnamurthy

#**, *** *****, ***. ****** galaxy

Vrushabavathi Nagar, Kamakshipalya

Bangalore -79

Educational Qualification

Course

School/College Name

University

Board

Year of

Passing

Percentage

SSLC

Govt High School Tayalur

KSEEBOARD

2004

56.64 %

JOC

Sharada Women’s College

Mulbagal

SCVE BOARD

2006

79.93%

BBM

Govt college for

Women Kolar

Bangalore

University

2009

57.27%

Computer Skills

Basics like MS-Office, Word, Excel, and Power point And other Software Operating

Typing English

Personal Skills, Strength and Abilities

Good communication and inter-personal skills.

Dedicated, Honest and Self confidence.

Quick Learner.

Good domain knowledge.

Ability to handle pressure situation.

High attention towards professional work.

Positive Attitude.

Friendly attitude.

Experience

4 years work experienced as a Senior claim Process Consultant in at Hinduja Global Solutions Pvt Ltd, Bengaluru (Achievements – Top gun awards for highest production with 100% quality).

Job Profile

Working in Member claims End to End team (Actisure application) with Health Insurance claim processing knowledge.

Helping to the team members in the claim processing and clearing their doubts.

Reporting the status of daily assignment to the manager.

Communicating with the client through emails for any escalations and responding on time for the emails.

My Roles and Responsibilities

Performed medical billing and adjustments for claims.

Assisted members, physicians and hospitals with queries and concerns on accounts.

Navigated through various databases and programs for updating and maintenance daily.

Daily follow-up on claims and correspondence.

Provided information to members on various benefit insurance packages offered.

Provided ICD-9 and diagnostic codes for claims and medical procedures.

Maintained, correlated and prepared medical records and files of members.

Maintain communication with providers for claim clarification.

Determined if claim submission was completed correctly, verified data and entered into system for adjudication.

Worked directly with beneficiaries to resolve any errors and answer any questions regarding eligibility status.

Reviewed payments history to determine final payment amount, if any

Translated foreign language claims into English utilizing translation software, then manually checked and coded appropriately.

Processed claims adjustments when applicable

Responding to the queries from the client and the team through Email.

Mentoring to the newly inducted employees and auditing there claim till they moved to production.

Responsible to achieve the set targets in terms of production and maintaining 100% quality within Turn Around Time (TAT).

Handling escalation mails and responding back to the clients.

Assigning work to the team and daily inventory tracking.

Personal Details

Name : Swathi.R

Husband's Name : Kishore.M

Date of Birth : 19/03/1988

Sex : Female

Marital Status : Married

Nationality : Indian

Languages Known : Kannada, English, Hindi, Tamil &

Telugu

Declaration

I hereby declare that all the above information is true, correct and complete to the best of my knowledge.

Place: Bangalore yours sincerely

SWATHI.R

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