Jayaseelan M

Dedicated and detail-oriented Claims Officer with 3.9 years of hands-on experience at Star Health and Allied Insurance Co. Ltd. Proven expertise in core operational billing and health insurance claims processing, documentation verification, and customer coordination.

Skilled in policy interpretation, fraud detection, financial approvals, and managing end-to-end claim settlements. Possesses a strong understanding of IRDAI guidelines and TPA coordination, committed to ensuring accurate and ethical claim handling while maintaining high customer satisfaction.

Claims Officer - Star Health and Allied Insurance Co. Ltd.

(2022-10)

• Processed and evaluated health insurance claims, ensuring strict compliance with policy terms and regulatory guidelines.
• Managed end-to-end Medical Billing and billing document execution within the claims workflow.
• Reviewed, evaluated, and issued accurate Financial Approvals and Combined Approvals.
• Verified medical documents submitted by policyholders and hospitals for accuracy, authenticity, and completeness.
• Generated and systematically addressed critical operational Queries to minimize data discrepancies.
• Supervised the complete lifecycle of claim disbursements, including final Payment Processing.
• Coordinated closely with TPAs, network hospitals, and internal medical teams to facilitate smooth and timely claim settlements.
• Identified fraudulent or suspicious claims through meticulous risk assessment and escalated them for comprehensive investigation.
• Maintained accurate claim records and prepared regular MIS reports for management review.

M.Sc.

• Computer Science - Thiru Vi Ka Arts College, Thiruvarur (2020 - 2022)

B.Sc.

• Computer Science - Swami Dayananda Arts & Science College, Thiruvarur (2017 - 2020)

H.S.C.

• General - Government Higher Secondary School, Alivalam (2015 - 2016)

S.S.L.C.

• General - Government Higher Secondary School, Alivalam (2013 - 2014)