Madineni Venugopal
Claims Processing/Medical Records Reviewer
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About
To work hard with full determination and dedication to achieve organizational goals. To enhance my creative abilities for optimum profitability of the organization. To give my best in professional pursuit for the overall benefit and growth of the company. Looking for a responsible and challenging career, where my skills can be effectively utilized and contribute to organization success.
Experience
Claims Processing/Medical Records Reviewer - HEALTH INDIA INSURANCE TPA SERVICES PVT. LTD.
(2025-02)
- Scrutinized medical reports, treatment plans, and hospital documentation to support claim validation and accuracy.
- Identified process gaps and collaborated with management to implement workflow improvements for faster claim processing.
- Investigated and resolved discrepancies in claim settlements, denial reasons, or short payments.
- Liaised with doctors, billing, and admission teams to facilitate seamless cashless admission and discharge processes.
- Ensured strict adherence to IRDAI regulations, insurance policy guidelines, and data privacy norms.
- Trained and mentored junior staff in cashless processing protocols and TPA systems.
- Prepared daily, weekly, and monthly reports on cashless claims status, rejections, and turnaround times.
Claims Processing/Medical Records Reviewer - RHEA HEALTHCARE PRIVATE LIMITED
(2023-09 - 2024-12)
- Handled pre-authorization and final authorization of cashless claims, reducing turnaround time and improving patient satisfaction
- Preparing Dis Summary.
- Reviewed and analyzed discharge summaries, medical records, investigation reports, operative notes, and treatment documents to ensure accurate clinical documentation and claims adjudication.
Education
B Pharmacy - Pharmacy - Sasstra college of pharmaceutical education and research (2024)
INTERMEDIATE - Narayana Jr College (2016)
SSC - Sri Sai Vijeta High School (2014)
