Madhumathi M

Detail-oriented Claim Adjudication Process Associate with experience in medical billing and health insurance claims processing. Skilled in claim validation, corrected claims review, eligibility verification, payment accuracy, and compliance. Proficient in CAS, CIS, Cotiviti, Macess, MS Office, and Tally ERP9 with a strong record of maintaining quality and productivity standards.

Process Associate – Claim Adjudication (Medical Billing) - Sagility India Limited - Chennai

(2024-06)

• Process Humana Health Insurance claims using CAS, CIS, Cotiviti, and Macess.
• Review corrected claims and ensure accurate adjudication and timely payment release.
• Handle HCFA and UB claims while verifying member eligibility, provider eligibility, coding accuracy, and supporting documentation.
• Perform corrected claim validations in accordance with business rules and compliance requirements.
• Identify and assist in resolving overpayments and underpayments, including refund processing.
• Consistently maintain high quality standards and productivity targets.

Bachelor of Commerce - B.Com - Justice Basheer Ahmed Sayeed College for Women