
Detail-oriented Ayurveda Physician with over 9 years in hospital and clinical settings, specializing in preventive healthcare and claims investigation. Expertise in analyzing claims, identifying risks, and ensuring accurate processing. Seeking to leverage extensive experience in a role focused on claims investigation, underwriting, or processing.
Conducted thorough audits of medical bills to ensure admissibility and accuracy.
Verified claims and negotiated with hospitals to secure optimal outcomes.
Engaged customers to resolve service-related issues effectively.
Identified fraudulent claims and policy exclusions through detailed analysis.
Investigated pre-existing conditions and other fraudulent activities diligently.
Conducted quality checks for Kasp-Ayushman Bharat Medisep and private insurance schemes.
Managed pre-authorization processes to ensure thorough verification before discharge.
Performed detailed analyses and follow-ups on pre-authorization requests.
Submitted post-discharge claims while maintaining compliance with all regulations.
Provided awareness sessions for doctors on scheme limitations and operational guidelines.
Resolved grievances through meticulous case verification and follow-up procedures.
Addressed query justifications to support timely approvals and disbursements.
Streamlined pre-authorization management to enhance process efficiency.