Magesh Mohana

Detail-oriented and performance-driven Healthcare Claims Specialist with 3.8+ years of experience in US healthcare insurance claims adjudication. Proven expertise in handling end-to-end claims processing for Medical, Medicare, and Medicaid plans. Strong knowledge of ICD-10 and CPT coding, policy compliance, and payer guidelines.

Skilled in tools like Act-Isure, Octopus, Salesforce, and Globalcare. Demonstrated ability to improve operational efficiency, ensure 100% accuracy, and mentor team members.

Healthcare Claims Process Specialist - Accenture - Chennai, India

(2019-09 - 2023-05)

• Project 1: Provider Claims (Client: Cigna)
• Processed 500+ provider and member claims weekly with 100% accuracy using Act-Isure and Octopus.
• Verified claim details including Member ID, Authorization, Coverage, Benefits, and duplication checks.
• Performed adjudication using ICD-10 & CPT coding standards and ensured timely approvals/denials.
• Participated in Agile sprints, improving processing efficiency by 15%, and trained new hires.
• Project 2: Data Capture (Pharmacy & Medical Claims)
• Extracted and validated pharmacy and medical claims data ensuring compliance with coding standards.
• Verified diagnosis and payment details; identified discrepancies improving data integrity by 20%.
• Generated comprehensive audit reports for leadership and compliance teams for performance tracking.

Bachelor of Commerce - B.Com - General - University of Madras (2019)

Higher Secondary Certificate - HSC - Valluvar Gurukulam Hr. Sec. School (2016)