Durgadevi Suriyaraj

• Streamlined data entry processes for increased efficiency and reduced errors.
• Provided exceptional customer service by promptly resolving provider inquiries and concerns related to their data.
• Enhanced provider data accuracy by conducting thorough audits and reviews of the database.
• Collaborated with cross-functional teams to ensure consistency in provider information across multiple platforms.

• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Followed up on denied claims to verify timely patient payment and resolution.
• Paid or denied medical claims based upon established claims processing criteria.
• Evaluated medical claims for accuracy and completeness and researched missing data.
• Monitored and updated claims status in claims processing system.
• Managed large volume of medical claims on daily basis.
• Identified and resolved discrepancies between patient information and claims data.
• Reviewed provider coding information to report services and verify correctness.
• Assessed medical claims for compliance with regulations and corrected discrepancies.

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As an adjuster, I will decide to finalize or reject the claim.
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Certified processor for processing “U.S Health Care Claims” by logging through Main frame system of Citrix application and adjudication the claims in “Customer-Server”. Claim is pulled by Ultra application and processed by Facets application.
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Validation the Members data in terms of Age, Lifetime Maximum, payable limits and other specific benefits with respect to the plan the member has chosen processes claims received by the Customer.
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Involves accessing the Member’s and Provider’s Databases.
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Validation the billed diagnosis codes, procedure codes and other details of services done to release the payment which is determined by CMS (Centers for Medicaid and Medicare Services)
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Claim Types involved: Member submitted claims, MB General, Radiology, Laboratory, OOA Claims, Emergency Services, Anesthesiology Services,
Inpatient and Outpatient Claims
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Processing claims as per the benefits guidelines
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Acquiring knowledge of related areas of the project
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Identify and resolve complex process related Claims on a day-to-day basis
Understanding and adhering to quality standards
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To process Facility, Professional and Member submitted Claims accurately and meet the daily targets
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Actively participation in all types of discussions like scheduling tasks, daily stand-up meeting, Enhancements discussions, etc.,
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Completed all assigned tasks well before the end time.
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