Summary
Overview
Work History
Education
Skills
Certification
Skills
Timeline

Sonal Prakash

Medical Officer -Auditor
Bengaluru,TG

Summary

Results-driven and detail-oriented Medical Claims Audit Officer with experience in conducting audits, reviewing medical claims for accuracy and compliance, and identifying discrepancies. Seeking a challenging role where I can utilize my skills to ensure the integrity of claims processing. I seek challenging opportunities where I can fully use my skills for the success of the organization.

Overview

7
7
years of professional experience
4
4
Certifications
2
2
Languages

Work History

Medical Officer

Mediassist
09.2023 - Current

-Review and process insurance claims for accuracy and completeness

-Verify policy information and coverage to determine claim eligibility

- Investigate and resolve discrepancies in claims to prevent delays in processing

-Perform audits on medical claims to verify accuracy, completeness, and compliance with regulatory requirements

-Develop audit reports and recommendations for process improvement and compliance enhancement - Ensure compliance with insurance regulations and company policies - Meet productivity and quality standards for claims processing

Consultant

Care Healthcare Insurance
12.2022 - 09.2023
  • Processed dental and medical insurance claims, including verifying patient information, treatment codes, and coverage details - Reviewed and corrected claim errors, discrepancies, and rejections to ensure timely payment
  • Assisted claims processors with data entry, documentation, and file maintenance
  • Communicated with customers and external partners to gather information and resolve issues

Junior Dentist

Roots Dental Clinic
02.2020 - 11.2022
  • Creating a medicinal prescription after studying the symptoms
  • Administrating patients with medicines
  • Understanding allergic reactions from mixing medicines
  • Diagnosing health/oral problems.

Internship

Chandra Dental College and Hospital
01.2019 - 01.2020
  • Creating a treatment plan to maintain or restore oral Health of Patients
  • Ensuring the safe administration of anesthesia
  • Good diagnostic skills using clinical knowledge and x-rays.

Education

EDUCATION
04.2001 -

-Advanced Management Programme for Healthcare (AMPH) -Indian School of Business (ISB)- 2023

- Certificate in Basic Life Support-Medvarsity2020

-Chandra Dental College and Hospital2020

BDS( Bachelor of Dental Surgery)-70%

-Rani Memorial Senior Secondary School2012

Intermediate (PCB)- 77%

-St. Anthony's Senior Secondary School2010

High school (PCMB)

8.6(CGPA)

Skills

Coordinated care activities with other professionals to ensure that the plan is integrated with the treatment plan

Certification

Certification in Medical Terminology 101 in 2024

Skills

  • Understanding of Claims adjudication / Claims Processing
  • Strong knowledge of healthcare regulations, compliance standards, and audit principles - Excellent analytical and problem-solving skills - Detail-oriented with a focus on accuracy and quality assurance
  • Effective communication and interpersonal skills
  • Ability to work independently and collaborate with cross-functional teams

Timeline

Medical Officer - Mediassist
09.2023 - Current
Consultant - Care Healthcare Insurance
12.2022 - 09.2023
Junior Dentist - Roots Dental Clinic
02.2020 - 11.2022
Internship - Chandra Dental College and Hospital
01.2019 - 01.2020
EDUCATION - ,
04.2001 -
Sonal PrakashMedical Officer -Auditor