KRISHNA KULAL

Roles and Responsibilities

● Adjudicate the healthcare claims from Leading third party insurance company in US.
● Accessing the member’s and provider’s database.
● Validating the member’s history for eligibility, plan and payment details.
● Reviewing the claims and physicians details.
● Validating the diagnosis code & CPT codes and the billed amount.
● Update all documents onto the respective portals
● If all details are correct then approve and pay the claim and send it to the accounts department.
● If any discrepancies are found in the claim then reject the claim by the appropriate reasons and send it back to the Physician.
● Initial membership process.
● Processing cobra coverage’s.

Additional Responsibilities

• Auditing processed Files or application through Epps application
• Conducting Team huddle and sharing the feedbacks to team
• Conducting process training and refresher training to new joiners
• Mentoring the new joiners and playing in the team
• Maintain a data of the team (production and quality)

• Handling the team and updating regularly intervals
• Re-adjudicating the claims
• Processing claims and releasing payment to the provider by using CAS application with in default date
• Resolving the provider issues and immediate response
• Handling client's escalations when requested by supervisors
• Following up the projects & closing it within Time limit