Lohith B G
Bengaluru
Summary
Multi-talented Senior Executive knowledgeable about Claims Processing, Auditing, Analyzing member and provider issues and appeals, operations and personnel management. Successful at stepping into motivating employees while establishing market dominance.
Overview
6
6
years of professional experience
Work History
Senior Claims Audit
Exl Service Holdings, Inc..
Chennai
03.2025 - Current
- Performed detailed audits of Humana inpatient hospital claims to validate correct assignment of ICD-10-CM/PCS codes and MS-DRG classifications.
- Reviewed inpatient claims for underpayment and overpayment identification, ensuring accurate reimbursement in alignment with Humana policies, IPPS methodology, and CMS guidelines.
- Verified accuracy of diagnoses, procedures, POA indicators, discharge status, and clinical documentation to support compliant coding and payment decisions.
- Identified DRG shifts, coding discrepancies, and documentation gaps impacting claim outcomes and collaborated with clinical teams/CDI specialists for clarification.
- Ensured compliance with official coding guidelines, CMS regulations, and Humana reimbursement rules while determining final DRG assignment.
- Provided audit findings, feedback, and coaching to coding teams to improve inpatient coding quality and reduce payment errors.
- Supported revenue integrity initiatives by minimizing payment variance, improving documentation specificity, and preventing reimbursement leakage.
- Assisted in continuous process improvement by analyzing audit trends and recommending corrective actions for accurate claim adjudication.
- Played a key role in strengthening Humana’s payment accuracy program through proactive inpatient claim reviews and DRG validation.
Senior Process Executive
Cognizant
Bengaluru
06.2022 - 01.2025
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Organized and reviewed Medical and Dental claims for completeness, accuracy, and took appropriate action to ensure procedures are followed.
- Identified process improvements, offered solutions to claim problems, and communicate recommendations to management.
- Coordinated benefits between members' claims and other insurance carriers.
- Trained to assist the team with processing of claims.
- Corrected underpayments. Reported and resolved overpaid accounts.
- Working both Medical process and Dental process at same time.
- Resolving client escalations and working on high priority claims and pends.
- Played a pivotal role in training and knowledge transfer for new team members.
- Consolidating the team production document and the Audit reports
- Sending error tickets to the adjuster and cascading audit errors to the team
- Evaluating the set-aside count and supervising the hourly output of the team
- Conducting a weekly assessment of the team and giving scores for their KRA
- Preparing MOM for daily huddle and reporting that with management
- Conducting refresher trainings, error discussion and fun activities for the team
- Drafting appreciation emails, updating process updates, distributing claims and acquiring overtime details.
- Developed a PowerPoint presentation on client training sessions to support auditors and the team in adhering to subsequent process steps.
Senior Quality Analyst
Hinduja Global Solutions
Bengaluru
09.2019 - 06.2022
- Researched issues related to claims processing to identify origins and implement corrective solutions.
- Reviewing insurance claims, identifying errors, and making recommendations for changes.
- Demonstrate experience in auditing insurance claims.
- Highlight knowledge of claim processing, coding, and reimbursement regulations.
- Detail expertise in medical terminology, including diagnoses and treatments.
Education
Bachelor of Commerce -
Bengaluru University
BengaluruPostgraduate Diploma in Business Administration -
Bangalore University
BangaloreSkills
- Microsoft office
- Email operations
- Communication
- Organizational skills
- Power Point Presentation
- Project planning
Languages
- English
- Kannada
- Hindi
- Telugu
- Tamil
Hobbies and Interests
- Social activities
- Sports
- Traveling
- Fitness workout
Awards
- Top Gun Award
- Amber Award
- Unicorn Award
- Perfect Experience Award
- Client Recognitions
Timeline
Senior Claims Audit
Exl Service Holdings, Inc..
03.2025 - Current
Senior Process Executive
Cognizant
06.2022 - 01.2025
Senior Quality Analyst
Hinduja Global Solutions
09.2019 - 06.2022
Bachelor of Commerce -
Bengaluru University
Postgraduate Diploma in Business Administration -
Bangalore University