Medical Claims processor

PROFESSIONAL SUMMARY

Self-motivated, Medical Claims processing professional with 3+ years of relevant experience available to offer professionalism and thoroughness to an insurance or medical company in need.

SKILLS

New Policies Processing

Claim Validity Determination

Problem-Solving

Insurance Claim Form Review

Medical Terminology

Proficient in using Computer System and Microsoft Office

Ability to write reports using healthcare and medical terminology

PROFESSIONAL EXPERIENCE

mediassist insurance tpa pvt. ltd. mumbai, india

Medical claim analyst march 2014 – February 2015

Accurately processed large volume of medical claims.

Evaluated pending claims to identify and resolve problems blocking auto adjudication.

Based payments or denials of medical claims upon well-established criteria for claim processing.

Sent Clinical requests and missing information letters to obtain, incomplete information.

Reviewed administrative guidelines whenever questions arose during processing of claims.

Verified policy holder data including age, contact number and physical address.

Checked documentation catching errors and making revisions.

Instructed clients on amounts covered under benefits plans in easy to understand terminology.

Modified, updated and processed existing policies and claims to reflect changes in beneficiary, amount of coverage and type of insurance.

Processed claims for payment or forwarded to appropriate personal for further investigations.

Updated patient and insurance data and input changes into company’s computer system.

Examined claims, records and procedures to grant approval of coverage.

Retained strong medical terminology, understanding in effort to better comprehend procedure.

mediassist insurance tpa pvt. ltd. Mumbai, India

Medical claim Processor September 2012 – May 2013

Accurately processed large volume of medical claims.

Evaluated pending claims to identify and resolve problems blocking auto adjudication.

Reviewed claims for accuracy before submitting for billing.

Inputted data into system, maintaining accuracy of provider coding information and reported services.

Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.

Based payments or denials of medical claims upon well-established criteria for claim processing.

Sent Clinical requests and missing information letters to obtain, incomplete information.

Reviewed administrative guidelines whenever questions arose during processing of claims.

Checked documentation catching errors and making revisions.

Instructed clients on amounts covered under benefits plans in easy to understand terminology.

Modified, updated and processed existing policies and claims to reflect changes in beneficiary, amount of coverage and type of insurance.

Processed claims for payment or forwarded to appropriate personal for further investigations.

Updated patient and insurance data and input changes into company’s computer system.

Examined claims, records and procedures to grant approval of coverage.

Retained strong medical terminology, understanding in effort to better comprehend procedure.

Ambulance Service 108 bhopal, india

Emergency Medical Technician - paramedic (On Job training & INTERNSHIP) Mar 2008– August 2008

Administered life support, first-aid treatment and other forms of prehospital emergency care to people who are injured or sick.

Operated equipment such as bag valve mask resuscitators, external defibrillators and electrocardiograms for advanced life support applications.

Administered drugs as appropriate and necessary via injection, intravenous procedures or oral administration under the direction of a physician.

Nutan girls coleege bhopal, india

Guest Lecturer Nov 2008–Dec 2009

Taught allied subjects/courses like anatomy and physiology to hospital management students.

Assist with the coordination and review of the Allied Health Program curriculum.

Evaluated students’ knowledge and progression within the program by using a wide array of assessment tools.

Promoting students’ success through growth based feedback.

Timely communication and implementing and divers learning strategies.

EDUCATION

Bachelor of Homeopathic Medicine and Surgery, August 2008

Narayan Shri Homeopathic Medical College, Bhopal, India

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