Summary
Overview
Work history
Education
Skills
Certification
LANGUAGES
PROFESSIONAL STRENGTHS
SPECIALTIES
Work availability
Timeline
Generic
Sushma Sharone Pereira

Sushma Sharone Pereira

Mangalore,India

Summary

Detail-oriented professional with extensive expertise in insurance claims processing, medical billing systems, and comprehensive medical documentation. Proficient in CPT, ICD-9, ICD-10 coding, and diagnosis-related group codes (DRGs), with a strong understanding of insurance policies and hospital billing procedures. Adept at front desk management, patient relations, scheduling, and complaint resolution strategies. Skilled in team coordination, reporting, and utilising MS Office Suite and Tally accounting software to streamline operations. Committed to leveraging advanced knowledge of medical terminology and current office practices to enhance organisational efficiency and deliver exceptional service.

Experienced professional with focus on supporting insurance operations and client relations. Capable of streamlining administrative processes and ensuring compliance through strong organisational skills and attention to detail. Delivers high-quality service by leveraging knowledge of insurance policies and procedures.

Experienced Insurance Assistant known for delivering top-notch customer service and efficient claims processing. Skilled in policy management and risk assessment, driving improvements in client satisfaction and operational workflow. Proven ability to streamline procedures, resulting in faster response times and reduced claim errors.

Overview

6
6
years of professional experience
2016
2016
years of post-secondary education
1
1
Certification

Work history

Insurance Assistant

ASTER DM HEALTHCARE
Dubai
2017.02 - 2019.04
  • Managed daily insurance operations, planning and organizing hospital insurance programming to ensure efficient workflow and timely claim processing
  • Prepared and submitted comprehensive documentation for property and liability claims, ensuring compliance with insurance provider requirements
  • Reviewed and analyzed insurance premiums, recommending appropriate internal distribution among funding sources while monitoring claim status until settlement completion
  • Maintained strong relationships with insurance providers while serving as primary liaison between patients, physicians, nurses, and insurance companies
  • Supervised front desk staff, monitored team performance, set KPIs, and resolved complaints to ensure smooth departmental operations
  • Clarified documentation discrepancies and coding errors, verifying healthcare charges against established rates for diagnosis, treatment, and services
  • Maintained patient accounts through automated billing systems, utilizing proper codes to facilitate insurance reimbursement and establish patient responsibility portions
  • Ensured strict adherence to occupational health, safety, and infection control guidelines

Receptionist cum Insurance Coordinator

MANGALA HOSPITAL & MANGALA KIDNEY FOUNDATION
Mangalore
2015.03 - 2016.06
  • Collected and verified proper documentation for insurance claim processing, including medical history review and coordination with treating physicians
  • Prepared and emailed Pre-Authorization letters with required signatures (patient, doctor, hospital stamp) to insurance companies
  • Submitted patient medical reports and doctor's documentation to insurance providers via email
  • Followed up on claims through email and calls for various insurance schemes including E.C.H.S (Ex-servicemen Contributory Health Scheme) and NMPT (New Mangalore Port Trust)
  • Addressed patient queries regarding claim settlement issues and maintained positive relationships throughout the claims process
  • Understood patient medical histories to ensure accurate claim documentation
  • E.C.H.S Claims Processing: Collected E.C.H.S cards from patients and submitted to department within 24 hours of discharge
  • Verified referral letters for OPD or admission purposes and coordinated emergency admission requests when referral letters were pending
  • Ensured patient signatures on all medical records at discharge
  • Submitted complete treatment records with doctor's signatures and hospital stamp to E.C.H.S office for claim processing
  • NMPT Claims Processing: Verified referral letters and coordinated with doctors regarding treatment cost estimates
  • Communicated treatment estimates to client companies via email
  • Coordinated with nursing counter, billing department, and reception regarding patient discharge timing
  • Collected original discharge summaries and treatment records for claim submission
  • Submitted original medical records to patient's company upon payment collection
  • Reception Responsibilities: Guided visitors and patients to appropriate hospital locations
  • Answered and transferred phone calls to requested departments
  • Performed clerical duties including photocopying, filing, and record maintenance
  • Booked and confirmed patient appointments
  • Ensured entryway and lobby cleanliness at all times
  • Maintained office stationery inventory and replenished supplies as needed
  • Assisted patients with medical form completion
  • Handled billing, receipt issuance, and patient database management
  • Scheduled follow-up appointments for patients

Customer Care Executive

PENINSULAR HONDA
Mangalore
2014.02 - 2015.01
  • Prepared daily reports on customer care team activities and performance metrics
  • Ensured timely and professional response to all customer requests, queries, and complaints
  • Maintained systematic recording and tracking of customer complaints and inquiries
  • Conducted follow-up calls to track customer inquiry resolution and satisfaction
  • Handled customer support issues via phone and email, maintaining detailed records in the system
  • Made soft calls and scheduled prospect appointments in coordination with sales and marketing teams
  • Developed and maintained positive relationships with external parties and customers

Sales Coordinator & Test Drive Manager

MONDOVI MOTORS PVT. LTD.
Mangalore
2013.06 - 2013.12
  • Attended to customers, provided information on vehicles of interest, and directed them to sales executives for further assistance
  • Responded to phone inquiries about vehicles and forwarded qualified leads to the sales team for follow-up
  • Managed customer support issues, ensuring timely and professional resolution
  • Prepared daily reports on customer care team activities
  • Ensured all customer requests, queries, and complaints received prompt and professional responses
  • Maintained comprehensive database of customer complaints and tracked close-out actions

Education

Post-Graduation Diploma - Human Resources Management

Mysore University
Karnataka, India

Bachelor of Arts - undefined

Mangalore University
Karnataka, India

Skills

  • Insurance claims processing
  • Pre-authorization and approvals
  • CPT, ICD-9, and ICD-10 coding
  • Medical documentation and billing
  • Front desk management
  • Patient relations and scheduling
  • Complaint resolution strategies
  • Team coordination and reporting
  • MS Office Suite proficiency
  • Tally accounting software
  • Medical billing systems expertise
  • HCPCS and DRG codes knowledge
  • Multimedia animation skills
  • Current procedure coding (CPT)
  • International classification of diseases (ICD)
  • Diagnosis-related group codes (DRGs)
  • Familiarity with hospital and professional billing
  • Comprehensive medical terminology knowledge
  • Understanding of insurance policies and processes
  • Current office practices and procedures

Certification

  • Diploma in Indian and International Accountancy
  • Diploma in Multimedia Animation

LANGUAGES

English: Fluent (Professional Working Proficiency)
Hindi: Fluent
Konkani: Native
Kannada: Native

PROFESSIONAL STRENGTHS

  • Outstanding communication and interpersonal skills
  • Excellent time management and organizational abilities
  • Good knowledge of Microsoft Outlook, Excel, and Internet Explorer
  • Ability to deal professionally with external and internal customers
  • Strong customer satisfaction and persuasion skills
  • Proven multitasking capability and ability to work under pressure

SPECIALTIES

  • Customer Service
  • Sales
  • Reception Management
  • Insurance Coordination

Work availability

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
morning
afternoon
evening
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Timeline

Insurance Assistant

ASTER DM HEALTHCARE
2017.02 - 2019.04

Receptionist cum Insurance Coordinator

MANGALA HOSPITAL & MANGALA KIDNEY FOUNDATION
2015.03 - 2016.06

Customer Care Executive

PENINSULAR HONDA
2014.02 - 2015.01

Sales Coordinator & Test Drive Manager

MONDOVI MOTORS PVT. LTD.
2013.06 - 2013.12

Bachelor of Arts - undefined

Mangalore University

Post-Graduation Diploma - Human Resources Management

Mysore University
Sushma Sharone Pereira