Team Leader
Send a job offer directly to this candidate
Detailed-oriented Team Lead professional offering 13 years in handling medical claims with expertise in health insurance principles, regulations, and practices; currently associated with Cognizant Technology Solutions Pvt. Ltd., Hyderabad as Operations Team Lead.
Ability to analyze & investigate claims, set reserves, determine compensability, and settle claims
ª In depth knowledge of policy limitations, medical terminology, and medical management
ª Thorough understanding of coverage interpretation and litigation
ª Experienced on US Healthcare Provider, Payer and Medical Claims
ª Deft in preventing insurer financial loss, assessing insurance claim validity, reviewing investigator findings, checking documentation, and making sure company guidelines are being followed
ª Proficient with computer and drafting reports on claim investigation
ª Credit of consistently delivering high-quality services to the business through informative, well-organized scope documents and business requirements
ª Adept at interacting with patients, understanding their requirements and devising customized solutions, thereby maintaining complete satisfaction, and creating opportunities for repeat business
ª Expertise in maximizing customer satisfaction levels through prompt resolution of business queries and qualitative service delivery
ª Worked with cross-cultural teams ensuring optimal utilization of resources leading to overall profitability; strong problem-solving, planning, team building and management skills
ª Demonstrated insurance claim expertise, attention to details, strong communication abilities, report writing skills, and computer competencies
ª Known for being cool and decisive during crises. Able to concurrently manage several ongoing tasks simultaneously
▪ Command of Insurance & Medical Claims
▪ Compensation & Settlements
▪ Quality Assurance ▪Troubleshooting & Problem Solving
▪ Requirement Gathering
▪Reports & Documentations
▪ Analyzing & Investigating ▪Leadership Skills
▪MedicalManagement/Terminology ▪ Team Management
▪ Principles, Regulations & Practices ▪ Client Relationship Management
ª Responsible for leading by managing a team size of 30 FTE’s.
ª Coordinate with US workflow team and assign the work to the team accordingly. ª Ensuring all the tasks are done within the TAT given.
ª Active participation in Monthly Deck and Weekly Deck
ª Utilizes documented team processes to ensure compliance with departmental standards
ª Reviews and distributes reports on work assignments, escalations, and/or QA results
ª Verifies data and processing requirements and make corrections as necessary
ª Plan cross training within the team
ª Manages day-to-day operations including balancing the workloads, attendance, and outage to minimize customer impact.
Prepare and Review Production and Quality reports and shared with clients on monthly basis.
Bachelors of Commerce from Madhurai Kamaraj University
