Pros
Having 3.8years in Claim Adjudication professional HEALTHCARE Department Experience in Claims forms Reviewing and processing the under workers composition Claims and KFI-key From Image related projects. ● Extensive professional experience in auditing, PMR audit Claim pending review claim managing Optum pend Claims KFI Claims and giving tasks complete to EOB Claims. ● Experience in KFI Claims review and processing the CMS-500 and UB-04 bills, non-format Claims, send back Claims and EOB – explanation of bills. ●Experience in audit queue, auditing the claims and processing the medical and hospital, non-format, send back, optum bills
Cons
• Good experience in the audit queue and auditing the KFI Claims. • Good experience in the SME queue claims, auditing the high dollar claims. • Good experience in then revaluation audit queue claims. • Having knowledge in managing the client mails making action plans and giving good responses to the clients. • Understanding the requirements planning to do work based on old dated claims and supporting the clearing the TAT. • Having good knowledge for team handling and giving clarification for the claim and supporting the team requirement. • Having Good understanding of difficult situations to solve the easy way good understanding and fast learning having capability for difficult situation to resolving capacity. • Intermediate to advance understanding of the other process claim bills and pending release Revaluation Optum. pending release and non-format claims review.
