Shruthi P S

Roles and Responsibilities

• Processing 100+ claims per day or Performing 250+ claim reviews per day
• Verifying provider Data in NDB(Network Database) screens and NPI Registry
• Research and Analysis of Provider Information from document
• Creating or Adding new providers to Database
• Modifying with new information available and correcting existing
• Sending provider information for further verification
• Resolving as per details availed from Call SharePoint
• Suggesting/Providing appropriate information for payment.
• Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
• Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
• Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.

• Vaccine Locator Team
• Roles and Responsibilities
• Researching, identification and obtaining the data/information needed
• Analyzing and Providing the Vaccination Information by updating on the SharePoint in Real-time
• Providing the Scheduling Information for the Appointments
• Identifying the Provider/Hospital Information for Vaccination and updating on SharePoint for End User
• Validating the Information on timely basis
• Recognizing and modifying the blockages and broken Information
• Updating the data as per State and City
• Other Responsibilities and Knowledge gained
• Been a Team player and conducted the activities for team refreshment
• Given a motivating presentation
• Learnt basics Of VBA Excel

• Analysis and Verification of the member and the provider
• Responsible to pay the correct provider the appropriate amount claimed
• Responsible for trouble shooting and handling the ageing claims
• Worked on ORS (online Routing System) for co-ordination of Payment
• Eradication of the Duplicate Claims by denying/Rejecting them Claim
• Checking the correct Place of service and services availed by the member
• Condensing/Combining the continual Claims for one Payment
• Sending the Claims for adjustment if there is any Over/Under Payment
• Using various tools to price the Claim
• Working Reclamation
• Calculating the appropriate Copay, Co-insurance and Deductible that need to be shared by member
• Checking for Notification and creating a duplicate Notification when requires
• Worked on Tired Copay, Sequestration, Hospice, Medicaid
• Rectifying any mismatch of member information, provider information/ Billed amount and reverting those with appropriate Letgen letter after proper verification by reaching out to the appropriate team and contact
• Maintaining the Quality and Production to the overall performance
• Following the company ethics and Values such as Integrity, Compassion, Relationship, Innovation, Performance
• Other Responsibilities and Knowledge gained
• Worked on TAT report
• Worked on highly difficult reviews and onshore escalations
• Worked under team leader and learnt the effective use of Microsoft excel