Summary
Overview
Work History
Education
Skills
Claim processing roles and responsibilities
Achievements Awards
Strength
Hobbies and Interests
Disclaimer
Timeline
Generic

SarathKumar S

Chennai

Summary

Experienced Claims Specialist with 4.5 years in healthcare services, adept at processing claims, negotiating settlements, verifying insurance coverage, and reviewing insurance cases. Seeking to contribute expertise in claims management to optimize operations and ensure accurate reimbursement.

Overview

5
5
years of professional experience

Work History

Subject Matter Expert

Cognizant Technology Solutions
08.2019 - Current
  • Working as a Subject Matter Expert 4.5 years experienced
  • Responsible for Error discussion in Team meeting
  • Handling the Team reports on daily and monthly Basis
  • Works as Processor and Auditor
  • Conducting team meeting BOD & EOD
  • Knowledge sharing session for new joiners
  • Have Good written, communication, interpersonal skills, proven team player
  • To work with mid-size teams, technical and business leadership
  • Claim processing roles and responsibilities
  • Verified claim information, including, member eligibility, coverage details, and provider contracts, ensuring compliance with company policies and regulatory requirements
  • Investigated and resolved claim discrepancies and disputes, collaborating with healthcare providers and policyholders
  • High-dollar claims undergo a specialized and thorough review process due to the significant financial impact and providers may appeal denied high-dollar claims, necessitating an efficient appeals process
  • This involves thorough documentation, understanding of appeal
  • Important of claims key works: Pre-authorization, COB, Duplicate, Member reimbursement, High $ , MOOP , Manual pricing as per the contract , Denial management.

Education

B.com (General) -

Alpha arts and science college – Madras University, Chennai
01.2017

Skills

  • MS Office ( World Excel & Power point)
  • Type Writing in English
  • Facets
  • WebStrat
  • Platforms ( Windows 7,10 and 11)

Claim processing roles and responsibilities

  • Investigated and resolved claim discrepancies and disputes, collaborating with healthcare providers and policyholders.
  • High-dollar claims undergo a specialized and thorough review process due to the significant financial impact and providers may appeal denied high-dollar claims, necessitating an efficient appeals process. This involves thorough documentation, understanding of appeal.
  • Important of claims key works: Pre-authorization, COB, Duplicate, Member reimbursement, High $ , MOOP , Manual pricing as per the contract , Denial management.

Achievements Awards

  • Reduced Claim Denials.
  • Increased Accuracy.
  • Enhanced Customer Satisfaction.

Strength

  • Effectively managing multiple projects simultaneously
  • Solving complex problems
  • Friendly and engaging personality
  • Facility for learning latest Tool faster
  • Assessing the needs and preferences of customer

Hobbies and Interests

  • Yoga and Meditation
  • Cooking
  • Drawing

Disclaimer

I hereby declare that all the information mentioned above is true to the best of my knowledge. I will make it my earnest endeavor to discharge competently and carefully the duties you may be pleased to entrust with me.

Timeline

Subject Matter Expert

Cognizant Technology Solutions
08.2019 - Current

B.com (General) -

Alpha arts and science college – Madras University, Chennai

Similar Profiles

CREATE PROFILE
SarathKumar S