Kishore M

Detail-oriented Claims Adjudicator with 1+ years of experience at Cognizant Technology Solutions specializing in US and Hong Kong healthcare insurance processes. Proficient in claims processing, medical coding validation (ICD-9 & ICD-10), and payer guidelines. Strong analytical skills with a focus on accuracy, compliance, and turnaround time.

Claims Adjudicaton - Cognizant Technology Solutions

(2023-08)

• Processed and adjudicated medical claims for US and Hong Kong healthcare systems in accordance with policy guidelines.
• Verified ICD-9 and ICD-10 diagnosis codes and ensured accuracy in claim submissions.
• Reviewed medical documentation and billing information to determine claim eligibility.
• Identified discrepancies, errors, and fraudulent claims, ensuring compliance with payer rules.
• Managed claim denials and reprocessing, improving claim resolution efficiency.
• Maintained high productivity and quality standards as per SLA requirements.
• Handled denials, reprocessing, and appeals, ensuring faster resolution and improved customer satisfaction.
• Conducted quality audits and supported internal QA processes to maintain compliance standards.
• Collaborated with cross-functional teams (billing, coding, and provider teams) to resolve complex claims issues.

Govt Arts and Science college (2024)

HSC - Vivekam Matric HR Sec School (2021)