Dhanisha S

• Established communication protocols with customers related to implementation timeline expectations.
• Tested various scenarios to ensure accuracy of data entry into the system.
• Liaised between clients and technical teams to ensure clear communication of project objectives and requirements.
• Ensured compliance with industry standards and regulations throughout the implementation process.
• Implemented new configurations based on customer requirements or industry standards.
• Developed and documented implementation plans for new software systems.
• Provided feedback on product features or design elements that could improve usability or performance.
• Monitored progress of implementations in order to meet deadlines set by clients.

Tools : HRP, Jira, SalesForce

• Analyzed system requirements to develop systems configuration plans and procedures.
• Implemented new configurations based on customer requirements or industry standards.
• Maintained detailed records of all Claim configuration activities including any changes made or tests performed.
• Monitored changes in system configurations to ensure compliance with organizational policies and procedures.
• Documented processes used in configuring existing systems as well as newly implemented systems.
• Prepared and presented technical proposals for clients.
• Maintained quality-focused performance benchmarks and schedules when directing project teams.

Tools :-ABS ,Macess

• Evaluated the validity of assigned claims by verifying that services are medically necessary according to established guidelines.
• Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
• Performed quality assurance reviews on completed work to ensure compliance with standards.
• Updated claim files and documented actions taken in a clear and concise manner.
• Followed up on pending claims and resolved issues delaying processing.

Tools & Applications :Citrix ,Mainframe (Qcare, Burgess )

• Provided guidance to customers regarding their rights and obligations under policy terms.
• Prepared detailed reports on claim status, payment history, and other relevant information.
• Verified documents to ensure accuracy of information provided by customers.
• Developed strategies for resolving complex claims issues.
• Prepared detailed reports summarizing claims outcomes and trends for management review.
• Communicated with policyholders to explain claims processes, coverage, and decisions.
• Followed all company procedures to keep data confidential.
• Documented audit results in accordance with established protocols and guidelines.