Nagarjuna R

Careform (CIMZIA Project) - Voice Process

• Verified patient benefits by contacting multiple insurance companies to confirm coverage for CIMZIA (Drug Code - J0717), ensuring timely access to medication.
• Gathered crucial policy details, including annual deductible, copay, and coinsurance information, to assist healthcare providers in making informed decisions before prescribing the drug.

Athena - Non-Voice Process

• Accessed and reviewed insurance company portals to check claim status, payment information, and denial details.
• Retrieved and uploaded EOBs (Explanation of Benefits) using payment batches for the posting team to facilitate accurate payment posting.
• Monitored and followed up on appeal statuses and verified patient eligibility information to resolve claims before escalation to calling teams.

Athena - Voice Process

• Contacted insurance companies to confirm the status of claims—whether paid, denied, or requiring additional documentation to process.
• Requested EOBs over the phone for paid claims and initiated follow-up actions for denied claims .
• Focused on identifying and resolving claims denials, gathering key information to address reasons for denial, and finding solutions to overturn them.
• Demonstrated a strong commitment to quality by maintaining strict adherence to established quality standards on each and every claim handled.
• Regularly Connected with the QA team to review performance and align with client requirements, ensuring seamless integration of updates into daily workflows.
• Documented all interactions and details gathered during calls, ensuring comprehensive and accurate records for follow-up actions by the next team member.