DINESH KUMAR M
Chennai
Summary
Detail-oriented professional with over 2 years of experience in the US healthcare sector, specializing in claims and internal auditing. Skilled in analyzing medical claims for policy compliance and identifying discrepancies to enhance process accuracy. Committed to maintaining quality standards, minimizing errors, and driving operational efficiency in high-volume environments.
Overview
3
3
years of post-secondary education
2
2
years of professional experience
Work History
Claims Processor
CORONIS HEALTH
Thoraipakkam
05.2024 - Current
- Processed US healthcare claims per client guidelines and policy terms, consistently meeting targets while upholding quality benchmarks.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Evaluated medical claims to ensure accuracy and completeness before processing.
- Calculated benefits due based on policy terms and claim information.
- Resolved claim discrepancies, denials, and exceptions within defined turnaround times, ensuring accurate claim processing.
- Ensured compliance with HIPAA regulations & internal quality standards during claim handling
- Analyzed claim data to identify trends and potential areas for improvement.
- Followed up on pending claims promptly, contributing to workflow efficiency.
- Provided technical guidance and training to new staff members regarding claim processing procedures.
Education
B.sc - Mathematics
Sir Thiyagaraya Collage
Chennai , India 07.2016 - 01.2019
Skills
- Claim processor
- CMS 1500, UBO4
- COB/EOB
- Claim Rekey
- Member Submit Claim
- Benefits calculation
- Internal Auditing
- NPI Registry
- MS Excel, Outlook
- WGS/PLM
- Problem solving
Languages
English
Upper Intermediate
B2
Tamil
Proficient
C2
Timeline
Claims Processor
CORONIS HEALTH
05.2024 - Current
B.sc - Mathematics
Sir Thiyagaraya Collage
07.2016 - 01.2019