ESWARAMOORTHY N
Coimbatore
Overview
7
7
years of professional experience
Work History
Senior Process Executive
Cognizant Technology Solutions
Coimbatore
07.2023 - Current
- Conducted thorough analysis of claims and complaints, drafting precise appeal letters for clients.
- Utilized analytical skills to research complex issues and apply decision support tools for case evaluations
- Researched and resolved payment issues, identifying root causes of appeals effectively.
- Managed incoming appeals, ensuring timely responses to members regarding service disputes.
- Adjudicated medical claims in compliance with CMS guidelines and internal policies.
- Utilized medical billing knowledge to determine claim eligibility and payment approvals.
Senior Associates- Claims Adjudication
Wipro Limited
01.2021 - 01.2023
- Assisted Medical Claims Examiners in reviewing approved claims for payment, ensuring information is accurate.
- Reviewed claim requests to determine eligibility for processing and escalate to management as necessary.
- Conducted claims adjudication of outside area medical claims using research and application of basic math skills; applied appropriate benefits to patient claims while adhering to HIPAA privacy laws and internal corporate confidentiality rules.
- Coordinated benefits between members' claims and other insurance carriers.
- Resolved all claims within a timely manner
HC & Insurance Senior Representative
NTT DATA Global Delivery Services Private Limited
01.2019 - 01.2021
- Claim Adjudication project involves learning the Managed Care Concepts in the US Healthcare Industry.
- Processing 'U. S. Health Care Claims' by logging through Citrix Metaframe and adjudicating the claims in 'Customer Server'.
- To review claim information in both electronic & paper media in order to determine the nature of the member's injury & illness.
- To determine & understand the coverage provided under a member' Plan.
- To utilize multiple systems to obtain & record claim information, perform statistical coding, data entry & data review to make claim payment decisions.
- Validating the Member's History for Eligibility in terms of Age, Dollar Limit, Lifetime Maximum, and other specific Benefits with respect to the plan the member has chosen processes claims received by the Customer.
- Audit claims to ensure that the team meets the Required SLA as per matrices.
- Conduct error review meeting weekly and provide feedback to the examiners.
- Handling Medicare, Medicaid, Imc, Dental Claims.
- Monitoring the ongoing quality of processing, troubleshoot problems and identify ways to improve the efficient way of processing.
- Weekly Wall Of Fame (16-jan to 20-jan)
- Weekly Wall Of Fame (12-dec to 16-dec)
- Weekly Wall Of Fame (10-oct to 14 -oct)
Education
BA - Tamil
Annamalai University
Skills
- HIPAA mandates
- Collections practice
- Teamwork
- Medical billing
- Claims processing
- Insurance verification
- Problem-solving
- Data interpretation
- Metrics interpreting
- CMS 1500
- UB 04
- COB
- EOB
- Medicare claims
- Medicaid claims
- Mental health claims
Projects
Community Health Plan Of Washington, NTT DATA, 01/01/19, 12/31/21 Change Healthcare, Wipro, 01/01/21, 12/31/23
Hobbies and Interests
- Cricket
- Photography
- Music
- Gardening
Languages
- English
- Tamil
Timeline
Senior Process Executive
Cognizant Technology Solutions
07.2023 - Current
Senior Associates- Claims Adjudication
Wipro Limited
01.2021 - 01.2023
HC & Insurance Senior Representative
NTT DATA Global Delivery Services Private Limited
01.2019 - 01.2021
BA - Tamil
Annamalai University