K.Naveen Kumar
Senior Claims Associate
Hyderabad
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 9 years of Health insurance experience.
Overview
12
12
years of professional experience
3
3
Languages
Work History
Sr. Claims Associate
United Health Group
06.2012 - 09.2018
- Worked in C&S (Community and States) Process, which Deals with Medicaid and Medicare claims
- Responsible for handling different types of medical claims and Hospital claims
- Processing claims with 100% accuracy & achieving 100% targets
- Achieving good quality and developing the process towards the achievement of revenue & profitability targets
- Before processing claims in Facets application Worked in Diamond application as it was post application and updated to new version that is CSP Facets
- Responsible for auditing the claims
- Keeping the Track of Hourly production Report
- Validating the information on all medical claims received
- Process Medicare and Medicaid Claims in CSP Facets in Few States are Wisconsin, Michigan and Washington States and these are state Specific plans works accordingly.
legal Senior Claims associate
Epiq Global Solutions
08.2020 - 10.2021
- Email correspondence process
- Handling multiple legal claims like Cook vs Santee, Fox vs Lowa, Alvarez b Sirius , Burch vs Whirlpool, Coffeng vs Volkswagen Settlement, Disposable Contacts Antitrust Litigation, Garvin vs Unified Port of San Diego, Ucla Health Data Breach Settlement.
Sr. Claims Associate
Optum Global Solutions
09.2021 - Current
- PAYMENT INTEGRITY Process
- Analyzing each claim to make sure that they followed proper guidelines and procedures
- Worked with several clients on developing streamlined claims process
- Managed high volume of medical claims on daily basis, prioritized workload based on receive dates, minimizing turnaround time
- Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
- Maintain detailed report on daily basis to management with inventory status, daily counts of processed claims, production sheets and audit sheets
- Assisted management in generating detailed reports, distribution of claims or workflow to team, peer training, mentoring, and maintaining positive support to new hires
- Performing internal audits on daily basis to save the team from corporate errors and maintain team quality
- Worked on Applications such as Clinical Point, CPA, , Empirical, & OnBase.
Education
B.com -
Matrusri Degree College, Osmania University
Hyderabad 04.2001 -
Skills
MEDICARE
Medicaid
Auditing
Management
Settlement
Storage Area Network(SAN)
Good Communication
Accomplishments
- Submitted 15 Bright Ideas in the Bright Idea drive with tentative saving of $ 100,000.
- Received 18 Special expertise award, Star and Venus Star awards in United Health Group for good performance.
- Worked as Quality Auditor for Pilot Process for total 13 members of team, and helping as an OJT support for the team.
- Successfully completed the many special projects in Medicaid (Wisconsin, New Mexico, Maryland, and Washington States).
- Also worked as Auditor for 12 months and Focus Auditing claims of MD & WA Team.
- Also Involved in Team Engagement Activities like Fun Spoc, Coverage of Events for UFL.
- Participated in many School program events conducted By UFL Team and UCARE Team.
Timeline
Sr. Claims Associate
Optum Global Solutions
09.2021 - Current
legal Senior Claims associate
Epiq Global Solutions
08.2020 - 10.2021
Sr. Claims Associate
United Health Group
06.2012 - 09.2018
B.com -
Matrusri Degree College, Osmania University
04.2001 -
Personal Information
- Date of Birth: 10/06/87
- Nationality: Indian
Self Assessment
- Ability to work well, both as an individual & in team environment.
- Good team player with effective organizational and good communication skills.
- Strong desire to learn and work on new project.
Disclaimer
I hereby declare that all statements made herein are true to the best of my knowledge and belief.
Personal Information
- Father's Name: Muthyamaiah
- Date of Birth: 06/10/87
- Nationality: Indian
Self Assessment
- Ability to work well, both as an individual & in team environment.
- Good team player with effective organizational and good communication skills.
- Strong desire to learn and work on new project.
Disclaimer
I hereby declare that all statements made herein are true to the best of my knowledge and belief.