SONIA G R

1. Scrutiny of medical documents and adjudication

2. Assess the eligibility of medical claims and determine financial outcomes

3. Cordinate with underwriting team/ network team/ technical team in case of fresh policy / claims with pre-existing disease by preparing excel with details of claim and suggest for denial/ approval depending on the necessity

4. To recognise red flags in certain cases where there might be claims of higher value in future and discussing with superior departments

5. Identifying trigger factors of insurance frauds and inform the concerned department and taking appropriate decisions

6. Making deductions for irrelevant investigations done /extended stay in hospital to control financial loss

7. Maintaining TAT of cases solving every document in period of less than 20 minutes

8. Coordinating with team to achieve every day Target

9. Bearing high end loyalty towards work and work place

7.

• Collected information about patient histories, current conditions and vital statistics to make accurate determinations about conditions.
• Trained and supervised medical students and residents engaged in special activities and procedures.
• Performed clinical procedures such as collecting blood.
• Wrote and updated patient prescriptions.
• Educated patients about procedures, conditions and medications.
• Provided routine and emergency medical care to patients.
• Kept informed on advancements in field to contribute to medical research programs.
• Entered and scanned patient history, current medical conditions and medications into novel EHR system.
• Directed and coordinated patient care activities of nursing and support staff.
• Completed patient referrals to other medical specialists.
• Confirmed consistent and accurate medical recordkeeping practices.
• Improved patient outcomes and delivery of care through improved clinical quality processes.
• Applied continuous process improvement strategies to enhance case management, programs and clinical management.
• Interpreted diagnostic test results for deviations from normal.
• Led diverse team of medical and administrative professionals in day-to-day clinic activities such as patient care, new business development, and patient relations.
• Assisted senior physicians and surgeons during assessments, examinations and surgical interventions.