• Conducted denial analysis training for doctors and staff to improve understanding of denial trends and corrective actions • Performed root cause denial analysis and prepared presentations for management to support decision making • Guided team members on strategies and best practices to minimize overall denial percentage • Handled submission, resubmission and reconciliation of optical claims to ensure accurate and timely revenue capture

• Manages end-to-end execution of insurance claim submissions, re-submissions, query management and justification for final reconciliation of the claims for clinics and Medical Centres. • Oversees clinic registration on eClaim and various insurance portals. • Ensures accuracy and completeness of clinical coding across the team, aligning with insurance standards and regulatory guidelines. • Collaborates with IT teams to optimize system functionalities, integrating insurance policy rules and automating claim workflows. • Conducts onboarding and continuous training for doctors, nurses, and administrative staff on insurance policies, claim procedures, and documentation protocols. • Leads regular training sessions for admin teams on the importance of maintaining comprehensive medical records and supporting documentation. • Provides ongoing updates to clinic staff regarding policy exclusions, non-covered services, and eligibility criteria. • Administers Life Group’s staff medical insurance coverage, managing policy categories and ensuring compliance with coverage terms.

• Obtaining timely pre-approval for OP and diagnostic patient procedures and follow through the pre approval process by providing necessary supporting documents. • Obtaining approvals for medicines through PBM. • Claim verification. • Submission of all cashless claims within the time limit as per the terms of individual TPA/ insurance company. • Downloading and uploading remittance advice from e-claim. • Uploading of XML files for re-submission. • Re-submission of rejected claims with the supporting documents. • Maintaining confidentiality of all documents and information in accordance with the facility policy. • Maintaining cordial relationship with insurance providers.