INSURANCE CLAIM SPECIALIST

I have Four year experience in healthcare industry at Insurance claim specialist,Handling Outpatients and Inpatients E-Claims for United health group (USA) insurance company.

Excellent in MS-Office, Excel.word document and excellent knowledge in Internet & Web application,typing speed is 30 wpm.

  • A good team worker
  • Good leadership quality
  • Passionate towards work
  • Hardworking and fast learner, patience
Last Resume Update November 6, 2018
Address Abu Dhabi, United Arab Emirates
E-mail Locked
Phone Number Locked

Experience

Serco Global Services
Senior Associates
Oct 2013 - Jun 2015

NATURE OF WORK: OVERPAYMENT CLAIMS
Work Profile: - USA HEALTHCARE INDUSTRIES
ACCOUNT PAYABLE:
• Recoup (offset) process and cash posting working on client escalation.(USA process).Recoup means Overpayments amount paid by insurance Payors.
• Resolving zero paid remits,settling overpaid accounts against underpaid one.
• Remits also mainly called has EOB. EOB Means Explanation of Benefits.
• Using CARS and Mediar system Transfering money from one account to another account.
• CARS system Full forms is Consolidated Accounts Receviable System & For Mediar no full form.
• Frist we bifurcate Amount belongs to which system and then processing it.
• EFT Means Electronic Fund Transfer. Money mainly transferred through Electronically by using CARS & MEDIAR System.
• EFT Check and Paper check details provided by insurance payors.
• Sending mail to offshore to get approval of more than 5 Lakhs Amount Dollar check for transcation and than only Processing it.
• Along with EFT and paper check all EOB detail & informations all also provided in its.
• As per remits (EOB) information given all details like Insurance Payors Name, Patients name,Patients account Number, Invoice Number,Claims Number, Date of service & Amount.
• In case we didt get proper information then we have access to get login ID to acess at payor websites as per EFT Number we get Remits.
• Insurance Payors name like, Caremark, Tricare for life, Humana, Carecentrix, Aetna, Anthems, Blue Cross blue shields etc around more than 3000 insurance payor are there.
• We use to sorts all the informations of remits into a excel sheet and calculations works done.
• Over all the Payments Settlement works done in this process.

Education

Mumbai University
B.Com (Banking & Insurance)
Jun 2012 - Jun 2013

I am Graduate in B.Com in Banking and Insurance.

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