Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Timeline
Generic
Prabakaran N

Prabakaran N

Chennai, Tamil Nadu

Summary

Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Senior Process Executive

02.2015 - 06.2022
  • Complex Medical claim adjudicator: worked any UB-04 claims 50 Per day
  • Adjudicated complex medical benefit claims Type of Bill 13x, 14x, 83x 81x 72x etc..
  • ICD 9 and ICD 10
  • Reviewing denial claims for payment
  • Medical claims adjudicate or review and scrutinize claims, processes claims into the computer system and matches claim data with the right authorizations
  • Also determine accurate claims payment or denial identifies and elevates doubtful claims and authorizations or system issues as suitable
  • Medical claims adjudicator has to work under close supervision
  • Researched issued, requested additional information, and collected written responses
  • Followed all regulatory requirements and procedures
  • Reviewed medical reports related to disability claims
  • Authorized tests and conferred with medical facility and professional regarding payment
  • Now I am handled Million dolor and low dolor claim only
  • Medical claim adjudicator:
  • Medical claims adjudicate or review and scrutinize claims, processes claims into the computer system and matches claim data with the right authorizations
  • Also determine accurate claims payment or denial identifies and elevates doubtful claims and authorizations or system issues as suitable
  • Medical claims adjudicator has to work under close supervision
  • Researched issued, requested additional information, and collected written responses
  • Followed all regulatory requirements and procedures
  • Reviewed medical reports related to disability claims
  • Authorized tests and conferred with medical facility and professional regarding payment
  • Validated all claims completely and accurately

Chennai
07.2022 - 01.2022
  • SME Roll and responsibility:,
  • Role Playing as SME in all the activities including the client calls and other Quality meetings including escalations
  • Understand basic and systematic approaches to manage projects/programs
  • Excellent oral and written English skills
  • Feedback given to examiner for their error and taken RCA (Rout Cause analysis)
  • Knowledge in claims adjudication and very well about HCPCS, CPT, DX codes
  • We are processing network and out of network provider
  • Taken HIPPA, PHI, PII course every years once
  • We are applied COB details when comes with claims form and pay as per Guidelines Co pay, Co insurance or Deductible
  • Processing claims in ABS and Macess toll and release the claim at timely basis
  • Received Reper DOC for reprocessing, if Reper received with respective doc Then process the claim ABS tool as per guidelines and pay the claim
  • Handling a team of 31 members and being responsible for their quality and Production.

Claims Subject Matter Expert

Cognizant Technology Solution India Private Limited
Chennai
- 02.2015

Education

B.Com -

University of Madras ( studied in Mohamed Sathak College of Arts and Science
2013

HSC - undefined

State board (Government Higher Secondary School)
2010

SSLC - undefined

State board (Government Higher Secondary School)
2008

Skills

  • MS office
  • Handling a team of 31 members and being responsible for their quality and Production
  • HCPCS Coding Guidelines
  • Insurance and payment benefits
  • DRG and PC Grouping
  • Research and Data analysis
  • Excellent Problem solver for difficult claims
  • Records Management UB04 claims form
  • ICD-10 (International Classification of disease Systems)
  • HCPCS and CPT (Healthcare Common Procedure Coding System) and (Current Procedural Terminology)
  • Claims processing and Payment procedures
  • Understanding Claims adjudication and reprocessing

Accomplishments

  • Worked in Healthcare Industry for over 7 years with Centene Corporation successfully trained new hire associate for healthcare claims adjudication and worked as a Claims subject Matter Experts for Cognizant Technology Solution Ind
  • Pvt Ltd.

Certification

  • HIPPA, Cognizant Technology Solution India Private - 2022

Timeline

07.2022 - 01.2022

Senior Process Executive

02.2015 - 06.2022

Claims Subject Matter Expert

Cognizant Technology Solution India Private Limited
- 02.2015

B.Com -

University of Madras ( studied in Mohamed Sathak College of Arts and Science

HSC - undefined

State board (Government Higher Secondary School)

SSLC - undefined

State board (Government Higher Secondary School)

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Prabakaran N