Kavikavi 1966

BSMS-qualified medical professional with experience in health insurance claims adjudication, pre-authorization review, and medical necessity evaluation. Skilled in clinical documentation analysis, policy interpretation, and coordination with hospitals and TPAs to ensure accurate and timely claim decisions

Claim Adjudicator - Star Health Insurance

(2023-08)

Health Insurance Processing Doctor

• Reviewed and processed cashless and reimbursement claims as per policy terms and IRDAI guidelines.
• Evaluated treatment plans, hospitalization summaries, and diagnostic reports for medical necessity.
• Assessed pre-authorization requests for surgeries and inpatient treatments.
• Identified discrepancies and policy deviations to prevent claim leakage.
• Handled claim denials, query management, and appeal reviews.
• Ensured adherence to turnaround time (TAT) and quality standards.
• Mentored junior claim processors and provided training on medical documentation.
• Maintained strict confidentiality and regulatory compliance.
• Verified treatment protocols and hospitalization details before claim approval.

BSMS - Siddha Medicine - Sri Sairam Siddha Medical College and Research Centre (2023)

Twelfth grade - AKT academy matric hr. Sec. School, Kallakurichi (2016)

Tenth grade - AKT academy matric hr. Sec. School, Kallakurichi (2014)