Sr. Claims Executive at Corro health (2021-02 – Present)
Client – Change Healthcare
- Reviewed 1,000+ healthcare claims monthly against payer policies, medical documentation, and regulatory guidelines to determine eligibility and payment decisions.
- Resolved complex billing discrepancies by reviewing patient accounts, insurer payments, and contractual adjustments.
- Made independent decisions on account corrections, ensuring compliance with internal policies and external payer rules.
- Managed high-volume queues of pending accounts, consistently meeting monthly resolution targets.
- Made complex cover-style determinations on denied or underpaid claims, analysing medical notes, procedure codes, and patient history to decide whether to appeal or adjust.
- Deliver training sessions on evolving healthcare regulations and auditing best practices to enhance team productivity.
Sr Associate at Wipro (2018-08 – 2021-01)
Client – Change Healthcare
- Investigated underpayments and denials, gathering information from providers, insurers, and medical records to determine correct course of action.
- Applied contractual and regulatory rules to make sound decisions on claim adjustments and appeals.
- Identified trends in denials and recommended process improvements, reducing repeat denials by 20% in one year.
- Collaborated with clinical staff to clarify medical information before making coverage decisions.
- Tracked, analyzed, and interpreted trends in large datasets, leading to improved operational efficiency.
- Prepared clear written determinations for internal and external stakeholders, explaining rationale in plain language.
Sr. Process Consultant at Hinduja Global Solutions (2015-06 – 2018-08)
Client – LabCorp
- Integrated and maintained healthcare data from diverse sources, enhancing data accuracy.
- Assisted in transforming raw health data into meaningful insights for strategic planning, contributing to reduction in operational costs.
- Managed data analytics requests, exhibiting project management and communication skills.
- Assisted in developing strategic plans based on data analysis, enhancing critical thinking skills.
- Supported senior analysts in the collection and analysis of healthcare data, resulting in the identification of key areas for improvement in patient care.
- Assisted in the development and implementation of data management protocols, contributing to an increase in data retrieval speed.
- Created and maintained comprehensive data reports that were utilized by hospital administrators to make informed decisions, improving overall strategic planning.
