Cooking
Sumana Ganiga
Senior Knowledge Specialist
Pune
Summary
To work in an innovative and demanding environment where I shall prove to be a valuable team member, contributing quality ideas and work for an organization where I can constantly learn and effectively deliver solutions to problems.
Overview
6
6
years of professional experience
3
3
Languages
Work History
Senior Knowledge Specialist
Mphasis Limited
Bengaluru & Pune
12.2022 - Current
- Working with company leadership to define project objectives, process, policies, Procedure and rules.
- Handling client calls, Mails and Escalations.
- Explaining policy implementation to fellow team members
- Worked in various process large group, medical letter reviewing, claims adjudication, Enrollment, Accounting.
- Reviewing bills and claims for accurate information.
- Entering data into company’s database, creating invoice to all the payments.
- Handling incoming and outgoing email and physical mail.
- Maintaining the SLA’s and TAT and quality as the process requirement.
- Handling questions, issued and providing detailed information on requirements process and policies.
- Working along with the automation team to implement new thing to the process.
- Assisting with billing and payment processing.
- Conducting information session, Resolving the issues and concerns as per daily updates received from client.
- Collaborated with cross-functional teams to achieve project goals on time and within budget.
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Followed all company policies and procedures to deliver quality work.
Senior process consultant
Hinduja Global Solution
Bengaluru
10.2019 - 12.2022
- I have experience in claims processing begins when a healthcare provider has submitted a claim request to the insurance company
- Processing UB04 and HCFA 1500 claims, covid claims and ER claims.
- I was responsible for processing insurance claims.
- Reviewing insurance coverage and analyzing claims.
- We are checking information like member id charge amount, Revenue codes, modifier, date of service, diagnosis codes, place of treatment.
- We are checking these information (Member information, provider, Duplicate, Benefit referral eligibility, Pricing resolution, Contact cis verification)
- MIS Reporting: claims cost summary report, weekly and monthly claims process report.
- Boosted client satisfaction ratings through timely issue resolution and proactive communication efforts.
- Provided in-depth training sessions for employees on updated processes and procedures.
Education
Bachelor’s in Science - Mangalore University
Bhandarkar’s Arts And Science College Kundapura
01-2019
Skills
Dedicated professional
Adaptable learner
Service excellence
Efficiency optimization
Effective team contributor
Effective time management
Interests
Travelling
Timeline
Senior Knowledge Specialist
Mphasis Limited
12.2022 - Current
Senior process consultant
Hinduja Global Solution
10.2019 - 12.2022
Bachelor’s in Science - Mangalore University
Bhandarkar’s Arts And Science College Kundapura
Disclaimer
I, Sumana, hereby declare that the information contained here in is true and correct to the best of my knowledge and belief.