Kesiya Varghese
Claims Felcitation Manager
Summary
Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and surveillance.
Driven, hardworking and veteran Registered Nurse bringing demonstrated patient care, medication monitoring and treatment management expertise. Adaptable and resilient with strong attention to detail, clinical expertise, and emergency response experience. Bringing-year record of success in nursing and desiring Nursing Incharge position with NABH facility.
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously.
Overview
6
6
years of professional experience
3
3
years of post-secondary education
Work History
Claims Manager
Star Health & Allied Insurance
BANGALORE
10.2017 - Current
- Determined proper course of action for claims processing.
- Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
- Interacted with Social Security Administration and other entities for timely processing and delivery of quality customer service and results.
- Manage up to calls and up to scheduled appointments daily to gather information to initiate claims process.
- Documented information gathered in field and uploaded data to company database for efficient processing using [Software].
- Examined claims forms and other records to determine insurance coverage.
- Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
- Documented and communicated timely claims information while supporting accurate outcomes.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Exceeded clients' expectations by compassionately gathering required medical and work history information to complete applications.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
Education
Associate of Science - Nursing
SNMVHS
Vannappuram, Iduki District, Kerala 08.2004 - 08.2007
Skills
Claims analysis,
Claims investigation and research
Insurance policy review
Nursing staff leadership
Patient and family education
Critical care nursing
Healthcare ethics
Clinical Documentation
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Manager
Star Health & Allied Insurance
10.2017 - Current
Associate of Science - Nursing
SNMVHS
08.2004 - 08.2007