Anees Mohammed

To succeed in an environment of growth and excellence. Which is applying for a suitable positon in your organization to work satisfaction and an opportunity to learn and growth as well as to achieve personal and organization goals to have a wonderful experience.

Senior Process Benefit configuration - SAGILITY INDIA PVT, LTD - Bengaluru

(2018-01 - 2023-12)

Worked as Senior Process Benefit configuration US Healthcare provider in a premier business process outsourcing company. Involved in medical record review and MRM inquiries along with claims adjudication. Linked to all major adjudication and re-adjudication processes. Verification and benefit configurations. And verifying with the bagging process on the contract code.

• Handling the high aging inquiries and processed accordingly.
• Responsible for achieving the daily and monthly target.
• Providing feedback to the process manager at the end of the day.
• Communicate clearly and effectively with clients.
• We are processing claims on HUMANA plat form with citrix Applications.
• Taking initiative in sharing new updates to the team on daily basis.
• Maintain the Audit reports weekly and monthly basis and analyze the Team quality.
• Major applications (Sciomine, MRM, CRM, Metavance, CCP).
• Handling associates with clarification when they are in Production ramp up.
• Experiences creating appeals and grievance and also identify drugs in argues as well.
• Assigning work to the associates and guiding them.
• Handling client's escalations when requested by supervisor.
• Sharing process updates with the entire team with team strength of 80 people.

Medical Officer - MAYFAIR WE CARE / TPA MEDI ASSIST

(2025-01 - 2026-12)

Worked as a Medical Officer involved in Claim adjudication and Benefit configuration for UK healthcare provider. Medical record review and MRM inquiries along with claims adjudication. Linked to all major adjudication and re-adjudication processes. Verification and benefit configurations.

Bachelor of Computer Applications - Computer Applications - RJS FG COLLEGE (2014-01 - 2017-12)