Experience

asha c n

Work experience
  • • Evaluate all claims and policy information and investigate all details for insured.
  • • Analyse the claim and check whether the claim need to pay or deny. Performing adjustment according to the specific instructions of the particular claim.
  • • Choose the correct provider using and verify with radar if the provider not active pend the claim to pv01.
  • • Request the medical records of the particular procedure core for the appropriate team.
  • • Check the claim has co-ordination benefits (COB) and explanation of benefits.
  • • Check the member is eligible to Medicare or not.
  • • Analysing the claim and evaluate pay the claim has primary or secondary based on claim information.
  • • Check the EOB (explanation of benefits) and update the EOB to pay the claim if don't have EOB requesting a EOB and deny the claim.
  • • Handling a report claim and duplicating a claim update a EOB.