Mastan Valli K

Claims Denial Analysis and Follow-Up:

Analyzing claims over the past 30 days and reaching out to payer representatives to obtain denial reasons.

Handling denials from insurance companies and ensuring the timely processing of claims.

Focusing on claims that are over 90 days old to ensure they do not exceed the timely filing limit.

Appealing claims denied due to timely filing expiration.

Appeals and Reimbursement Management:

Contesting denials based on timely filing issues by submitting appeals.

Retrieving medical records from the EMR (Electronic Medical Records) system and submitting claims along with the necessary documentation via fax or paper.

Following up on denied claims to ensure appropriate action is taken.

Low Payment Claim Analysis:

Analyzing and appealing claims with low payments, working with insurance providers to correct any issues and ensure proper reimbursement.

Calling insurance companies to address incorrect denials and resubmit claims for payment.

Team Management and Oversight:

Leading a team of 15 users, gaining experience in people management, and ensuring that team members are aligned with the objectives.

Maintaining and preparing reports on team performance and claims management.

Error Auditing and Correction:

Auditing processes for errors, identifying

mistakes, and taking corrective action to prevent similar issues in the future.

This summary emphasizes both your technical claims management responsibilities and your leadership skills. If you'd like any adjustments or further clarifications, feel free to ask!

• Met project scope and delivery dates by planning optimal testing schedules.
• Evaluated performance metrics from existing processes to recommend improvements in product quality.
• Simulated software production environments to allow for enhanced testing.
• Worked with off-site teams to complete timely tests and facilitate smooth product releases.
• Collaborated with cross-functional teams to develop and implement process improvements.
• Implemented a quality control process that improved product quality by X%
• Developed and maintained quality assurance processes that improved product quality and customer satisfaction by X%
• Developed a comprehensive quality assurance program that ensured all deliverables met the highest standards of quality
• Developed and implemented quality assurance programs that improved product quality by X%
• Developed and implemented a quality control system that increased product quality by X%

• Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
• Generated detailed reports regarding the progress of open cases for senior management review.
• Reduced loss ratios through fair and prompt processing of claims.
• Reviewed medical records for accuracy and completeness according to established guidelines.
• Verified liability extent with reviews of police reports, medical treatment histories and other records.
• Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.

• Maintained accurate records of all claims activities
• Analyzed complex claims to determine validity and appropriate settlement amounts
• Submitted claims to insurance carriers for payment
• Prepared and submitted claims for additional payment, resulting in a X% increase in project revenue
• Drafted and filed motions to dismiss claims, resulting in reduced legal costs for clients