Sandeep S, Commerce Graduate with 4.7 Years of work experience in US Healthcare domain with expertise and hands on knowledge in Claims Testing.

About

Commerce Graduate with 4.7 Years of work experience in US Healthcare domain with expertise and hands on knowledge in Claims Creating and Testing, Quality, Benefit Insurance Verification, Clinical Request and Workers Compensation, Medical Records Management. Looking forward to joining an organization that updates my skills as well as utilizes my knowledge and talent in the progress of the company.

Experience

Thryve Digital Health

Jan 2020 – Jan 2022

Hyderabad- India

Senior Process Analyst

Need to take the information from the Client portal and enter the information manually in selected PPO, HSA, Copay, Embedded and Non Embedded plans. Need to check the work items by using Tableau tool and check the market segment and service level agreement. We have to complete the work item with in Service level agreement and need to give the work items status to client in client call. We need to check the child items and need to do each and every child work item within market segment. We are using one portal like SharePoint form if we have a question we need to raise questions through SharePoint. If we did not complete the work item within service level agreement we need to intimate the difficult part to client in client call. We have client call for every two days we need to show and represent work item status and need to give proper explanation to client in client call. Directly we are reporting to client and we do not have any team leader in my process. After entering the information in, selected plans need to create a batch number on a daily basis for work items. Need to create a claim for every scenario and test the claim whether it is paying correctly or not. For one work item I need to create 45 claims. We need to take members for every scenario depending upon the age limit. If members are not found in the true group, they need to take members from the dummy group and update the dummy group in FCCR Tool. Need to check the Group Number, PID, Effective date, HCPC Code in OCWA. If information is not matching with ICIS, it needs to update in FCCR Tool. After completing the claims creating need to test whether it is paying correctly or notand need to check with OCWA.

Sutherland Health care solutions

Jan 2019 – Jan 2020

Hyderabad- India

Senior Associate

Understanding the requirement to process claims in a detailed way. Perform Quality Audits as per requirement. Coordinating with internal and external stakeholders. Identify, estimate and correct deviations and defects in the quality system process. Configure management required audits and perform customer staging. Inspect, monitor, record and report quality data for production and incoming activities to assist in operations. Need to review claim submissions, obtain and verify information, correspond with insurance agents and beneficiaries, and process claim payments. Need to create testing parameters for products and services, develop quality control procedures, perform audits, and oversee quality control teams. Monitor the quality of a company's products or services. They create testing parameters for products and services, develop quality control procedures, perform audits, and oversee quality control teams

Optum Global solutions

Jan 2017 – Jan 2020

Hyderabad- India

Claims Associate

Performing Benefits and Eligibility Check on patient accounts. Monitor and verify insurance information for individual patients and procedures Drafting methodologies to drive processes seamlessly. Communicate with patients about co pays, benefits, coverage and care authorization. Enter data, create reports and validate individual and cross-patient information. Evaluating claim and Policy information. Investigating details to determine the coverage. Obtaining Deductible, Copay and Coinsurance components from the patient account. Verifying Demographic information and Prior-Authorization are accurate. Check CPT, HCPC codes and all services are correctly billed. Gather all statements from members, providers and insurance companies to verify all facts of policy contracts. Evaluating claim status and obtaining resolution by coordinating with team members. Drafting methodologies to drive processes seamlessly. Monitor and verify insurance information for individual patients and procedures.

Education

Adikavi Nannaya University

Jan 2014 – Jan 2017

Business Management, Auditing, Finance.

Sandeep S

Commerce Graduate with 4.7 Years of work experience in US Healthcare domain with expertise and hands on knowledge in Claims Testing.

Skills

Languages