Kumaran R

Detail-oriented Senior Process Executive with expertise in U.S. healthcare claims adjudication and processing. Proficient in Medicare, Medicaid, and commercial insurance policies, with a strong grasp of CPT, ICD-10, and HCPCS codes. Skilled in claims validation, denial management, appeals, and compliance with CMS and HIPAA regulations. Adept at optimizing workflow processes, ensuring accuracy, efficiency, and adherence to payer guidelines.

Senior Process Executive ( Payment operations ) - Cognizant Technology Solutions

(2022-01 - 2026-04)

• Process and adjudicate U.S. healthcare insurance claims in compliance with payer policies and CMS regulations.
• Validate CPT, ICD-10, and HCPCS codes for claim accuracy and payment integrity.
• Investigate claim denials, appeals, and process pre-authorizations as per insurance guidelines. Ensure compliance with Medicare, Medicaid, HIPAA, and other regulatory standards.
• Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations. Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process.
• Ensuring accurate and timely completion of transactions to meet or exceed client SLAS.
• Maintained a 99.5% quality accuracy rate while processing 200+ transactions weekly exceeding client SLAS.

Bachelor of Computer Application - BCA - Sri Krishna adithya college of arts and science Coimbatore (2018-06 - 2021-05)