Vignesh Vijay
Claims Adjudication Specialist
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About
To work in self-disciplined environment and in a responsible position, seeking for a job in challenging and healthy work environment where I can utilize my skills and knowledge efficiently for organizational growth & personal goals.
Experience
Claims Adjudication Specialist - SourceHov India Private Limited - Chennai
(2020-01 - 2022-02)
Project#1: PacifiCare Adjudication - Project deals with the payment to the provider under the PacifiCare states. The pricing hierarchy starts from member validations to payment given the service rendered including member history, prior Authorization, Provider verification, code specific scenarios, Risk Arrangement. After completing all the verifications claim pricing using SOP under KL.
- Worked on US Healthcare insurance claims with solid background in working with applications
- Adapted at managing both routine and intricate tasks and scenarios
- Take responsibility of payment of all claims in compliance
Claims Adjudication Specialist - Accenture Solutions Private Limited - Chennai
(2022-02 - 2024-08)
Project #2: Aetna International Claims Adjudication - Project deals with the payment to the provider and member. As per the contract states rates will be applied and International claims will be processed based on the updates and payments will be done accordingly.
- Responsible for delivering high-quality results and Consistently meeting all targets
- Responsible for answering escalation claims and Handling customer needs
- Handling claims related to Health disability and life
Claims Adjudication Specialist - Cognizant Technology Solutions Private Limited - Chennai
(2024-09)
Project #3: Provider Written Inquiry(BCBS) Claims Adjudication - Project deals with payment to the provider. As per contract rates will be applied, worked both Host and Local claims for IL&TX states, and worked based on provider inquires and denied IRC's, finally sent letter response to provider when denial is maintained, if denial is overturned then adjusted the claim and released the payment to the provider.
Education
B.C.A - Computer Application - D.B Jain College, Chennai (2019-06)
Higher Secondary - C.S.I Kellett Higher Secondary School, Chennai (2016-06)
SSLC - C.S.I Kellett Higher Secondary School, Chennai (2014-06)
