Claims Adjudicator 2 Years of Experience
Sagility Healthcare India Pvt.Ltd.
02.2023 - 04.2025
- Investigated high volume of insurance claims to determine validity and coverage eligibility.
- processed adjudicated medicare and medicaid claims including CmS 1500,UB-04,Super bill and ADA bill.
- Executed claims processing, while generating increased revenue.
- Analyzed claims for eligibility, coverage, medical necessity, and policy compliance using CPT, ICD-10, and HCPCS codes.
- Utilized systems including Facets, Macess tool, for claims processing and documentation.
- tested system configurations and new process for clients.
- Trained and mentored 5 junior adjudicators, resulting in a 30% reduction in onboarding time.
- Communicated with clients to explain policy coverage and regulations.
- Reviewed and processed high-volume health insurance claims (PPO, HMO, Medicare/Medicaid) with 98%+ accuracy.
