Mohammed

EMPLOYMENT HISTORY DST Worldwide Services Tenure: December 2014 - December 2018 Designation: Senior Claims Associate Client: Long Term Care Group ( Continental National American Insurance Company ) Domain: Health Insurance / Health Care Roles and Responsibilities: Processing Insurance Claim of US Policy Holders ( Senior Citizens ) for their Health Care needs . Working on Insurance Claims received from client and paying benefits as per Insured’s Eligibility criteria. Analyzing details of Service Providers and Policy Guidelines of Claimant in order to ensure that claimant is approved for benefits before making payments. Paying benefits only after request for reimbursement is received which is of three types; namely, RFR Facility, RFR HHC ( Home Health Care Aide ) , RFR General. Honoring or Denying the claim accordingly based upon Insured’s Eligibility Criteria and after ensuring that complete and required information is received. Adhering to Client Guidelines and HIPAA Laws (Health Insurance Portability and Accountability Act) while making payments. Achievements in Organization: Frequently received Spot Awards after exceeding production output target. Worked on 100 Claims in a day while target was 40 per day. Actively contributed towards Organization’s needs and concerns by working on weekends. Received appreciation from Client for achieving an audit score of 100 %. Previously worked with Syniverse Technologies as a Project Consultant Tenure : 6 months contract Process : Migration Project ROLES AND RESPONSIBILITIES Reconciling and uploading Invoices. Aligning data on two platforms. Identifying the reasons for mismatches and taking action for resolution as per the appropriate guidelines. Publishing reports on a weekly basis to show the updated status. Successfully achieved 98% of targets for 8/10 customer waves.