Maha Lakshmi

I have overall 20 months experience in Claim Payment

Adjudication under Cigna health care domain.

*Roles & Responsibilities – US Healthcare Medical Insurance Payment Process*

*Claim Processing & Verification*

• Check patient insurance eligibility and coverage.

Review and validate patient information and insurance coverage.

• Assign appropriate medical treatment to procedures and diagnoses.

*Payment Posting & Reconciliation*

• Process Explanation of Benefits (EOBs)
• Payment paid for under cover the policy benefits and treatment

*Adjudication Decision:*

• Payment Determination: Based on the assessment, the insurer decides whether to approve the claim for full or partial payment.
• Denial or Pending Status: If issues are identified, the claim may be denied or marked as pending for further information.