Jossy Varughese

To be an integral part of an organization where I can apply my knowledge and professional skills to add value to the organization and continuously improve my professional career.

Dedicated Medical Insurance

Professional in investigating and processing medical insurance claims. Excel in analysing claims, interpreting policies, payer and provider relations, reconciliation, and negotiating payment solutions. Effectively manage multiple, high-priority claims and take pride in providing exemplary customer service.

Head of Claims Operations - Medical - Aafiya TPA - Dubai

(2016-06)

• Directed end-to-end medical claims operations, aligning intake, adjudication, escalation, reports and resolution workflows to improve turnaround time and service quality.
• Partnered with clinical, finance, provider relations, and compliance teams to ensure accurate claims processing and adherence to regulatory and payer requirements
• Implemented process improvements across claims handling procedures, reducing rework and strengthening operational consistency

Head of Insurance - Medical Insurance - Top Medical Group [Synergy Integrated Medical Centre] - Dubai

(2014-01 - 2017-05)

• Heading the insurance claims team
• Claims submissions, resubmissions, reconciliation and payment follow up with insurance companies.
• Update the Medical Coding (CPT) list in Billing Software or with Insurance Companies against the existing price list
• Arrange meetings with Insurance Companies
• Provide training to the team/reception.

Medical Insurance Claims Processor - Neuron LLC - Dubai

(2011-11 - 2014-01)

• Examine and process both paper and e-claims; check the validity of prescription, lab/radio request, and pre-authorization; ensure that claims are valid for processing and settlements are made as per contractual agreement and policy's terms & conditions.

NICU in-charge - Mamata General Hospital - Hyderabad, India

(2009-03 - 2011-03)

• Manage neonatal ICU.

B. Sc Nursing - Dr. NTR University of Health Sciences (2009)

Medical Coding and Billing Certification - AAPC

Senior School Certificate Examination - Kerala Education Board (2004)

Secondary School Certificate Examination - Kerala Education Board (2002)