komal zanjurne

Myself Komal, I would like to work with an organization which stimulates creativity and learning so that I can contribute to organization growth and at the same time continuously improve my efficiency and knowledge.

• MD India life insurance TPA Pvt ltd Pune – Technical Auditor (Oct 2021 – April 2023)

• Roles & Responsibilities: -
  • Verify Information: Ensure the accuracy of diagnosis codes, treatment procedures, service dates, and other claim details.
  • Adhere to Policies and Regulations: Apply relevant insurance policies, government regulations, and coding guidelines to assess claim eligibility and payment amounts.
  • Identify Potential Fraud and Abuse: Analyze claims for potential discrepancies, inaccuracies, or suspicious patterns that suggest fraud or abuse.
  • Communicate Effectively: Interact with healthcare providers, policyholders, and internal departments to clarify information, obtain documentation, and resolve discrepancies.
  • Communicate Effectively: Interact with healthcare providers, policyholders, and internal departments to clarify information, obtain documentation, and resolve discrepancies.
  • Maintain Documentation: Document all findings, decisions, and communication related to each claim reviewed.