Jeyaraj RAJADURAI
Summary
Experienced and self motivated HC and Insurance operation Senior Processor Associate with 9 years in US healthcare industry. Skilled in working under pressure and adopting to new situations and challenges to best enhance the organization brand.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Senior Processor Associate
NTT DATA Information Processing Services Private Limited
04.2019 - 04.2024
- Examine the patient demographic, Report date, Policy coverage, pre-onboarding policy/benefits review as per SOS's guidelines
- Handle claims registration for life Insurance and General Insurance personal lines with in TAT.
- Handle screening of medical bills to verify with policy information and status.
- Perform accurate submission of IP and OP claims. Set-up, Examine and Submit all IP and OP claims via Lifesys P-Term.
- Stayed current on HIPAA regulations, benefits claim processing, medical terminology, and other procedures in health and life claims services
- Ensure that all claim documents from clients are submitted to insurers within agreed timeframes (TAT)
- Screening of medical records and medical bills to verify with policy information and status
- Maintain proper medical records to enable the identification of claim trends and inform underwriters immediately of ant adverse trends
- Conduct recovery action against reinsures and thirds parties are taken without delay
- Process and review on claim settlements and approve with authority limit with using of Lifesys P-Term and Image portal and BCP
- Review claims appeal, exceptional handling, and escalation from Broker
- Ensure claim settlement documents are sent to clients in a timely manner
- Examine the electronically / manually received claim form, Fund transfer, medical records, UB-04 form, HIPPA bill, EOB bills, Diagnosis code and CPT codes for pay or denied the claims
- Liaise with and follow up with claimants, policy holders and agents on outstanding requirements
- Support claims officers in the requisition for payments on approved claims
- Examine the claims/policy for payment, if the documents not valid or need additional documents sent to NIGO process and draft letter (LSP) to client for requested documents.
Auto Injury Solutions
SOURCE HOV INDIA PVT. LTD
04.2014 - 12.2018
- Worked with 3rd party claims
- To Examine claims investigated by insurance Adjusters, further investigating questionable claims to determine policy liability
- Process and decide on claim settlement and approve within authority limit
- Determine the patient responsibility based on their insurance plans
- Enter insurance and patient payments into the practice management patient ledger.
Education
Bachelor Of Engineering - Electrical, Electronics And Communications Engineering
Anna University
Tamil Nadu, India06.2011
Skills
- Advanced Data Analysis
- Workflow Management
- Expert Communication
- Data entry experience
- Teamwork and Collaboration
- Multitasking and Organizing
- Microsoft Excel
- Problem-Solving
- Time Management
- Expert in LIfesys P-Term, SAP
- MS-Word
- Health and Life Insurance Policy
Certification
I have successfully completed the medical coding Training on Utilizing and Manoeuvring through the ICD-10 CM and CPT coding books also on an extensive syllabus of Medical Terminology, Anatomy and Physiology.
Languages
English, Tamil
Personal Information
- Father's Name: Jeyaraj. S
- Date of Birth: 08/30/88
- Gender: Male
- Nationality: Indian
- Marital Status: Married
Disclaimer
I do hereby declare that the particulars of information and facts stated herein above are true, correct and complete to the best of my knowledge and belief.
Timeline
Senior Processor Associate
NTT DATA Information Processing Services Private Limited
04.2019 - 04.2024
Auto Injury Solutions
SOURCE HOV INDIA PVT. LTD
04.2014 - 12.2018
Bachelor Of Engineering - Electrical, Electronics And Communications Engineering
Anna University