Obtaining a challenging position by applying creative problem solving and learning management skills and gain further experience while enhancing the company’s productivity
and reputation.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Process Executive
Access Health care
09.2024 - Current
Reviewed claim denials and payer requirements for corrective action and prevention in future
Maintained and departure of clinical records with respective cases and in a timely manner.
Followed up with insurance companies to resolve pending and denied claims.
Handled claim status checks, appeals, and payment-related queries with accuracy.
Analyzed aging reports and ensured timely collection of outstanding payments.
Identified root causes of denials and implemented corrective actions.
Skilled at working independently and collaboratively in a team environment.
Process Executive
Omega Health care
11.2022 - 10.2023
Worked in end to end process, which is the last source of payment to providers
Processing through Fax ,Mail and Portal
Reviewing Medical records and other valid treatment proofs.
Executed the clearing of front-end rejection of claims and appealed the claims towards resolution.
Reviewed claim denials and payer requirements for corrective action and prevention in future
Maintained and departure of clinical records with respective cases and in a timely manner.
Assisted with day-to-day operations, working efficiently and productively with all team members.
Education
M.com - Commerce
Prince Shri Venkateswara Arts And Science College
Chennai, India
01.2022
B.com - Commerce
Prince Shri Venkateswara Arts And Science College
Chennai, India
01.2019
Skills
Expertise in insurance follow-up and claim status verification
Understanding of EOBs (Explanation of Benefits) and denial
Claim status check and appeal follow-ups
Experience with provider portals (eg, Availity,UHC)
leadership and time management skills
Exceptional communication and interpersonal skills
Detail oriented and able to handle multiple tasks simultaneously
Effective in managing and supporting team operations
Proficiency in MS Word, MS Excel, Powerpoint
ACHIEVEMENTS
Received reward and recognition for team contributions.
Consistently achieved 100% quality score in call audits and documentation accuracy.
Maintained 100% compliance with HIPAA and client confidentiality standards.
Recognized as a Top Performer of the Month for exceeding daily call targets and maintaining call quality.
Ensured on-time closure of 95%+ pending claims, improving team productivity.