Midhun TP

• Process of Claims Adjudication which is responsible for Paying , Denying and Routing the bills.
• Processing the Mainframe Application[WGS] to Finalized the Transaction amount (US Dollar) to Provider.
• Have hands on experience in Claim Adjudication, Duplicates
• Hands on experience in Adjustment Claims.
• Very sound knowledge of claims processing and medical terminology.
• Processing complex cases that require special handling..
• Adaptive to any situations and ability to work in a team.
• Working for Enterprise Benefit Administration for US HealthCare part of Health BPO
• Handling a Sub process under a team. Trained on Benefit coding, Good knowledge Auto Adjudication (End to endprocess).
• Working experience in New group, Change request ,Renewal
• Adding Benefit and benefit changes Coverage plan
• Knowledge in Manual Adjudication and Auto Adjudication.
• Entitling the different types of applications in ‘Citrix Application’ system across USA.
• Attending weekly quality calls and discussing errors and updates with clients
• Extend my duties for the project needed
• Ability to work under pressure of deadline.
  Tool are handle:CMA,WPD,JIRA,WGS,CIW,BLUE SQUARE,WCF,QCARE,BUSINESS OBJECT,DCN KIOSK

Work Experience:                                                                                               

• Company: Cognizant Technology Solutions
• Designation: Process Executive (PE)
• Domain: US Healthcare domain
• Claims Adjudication
• Project : Anthem & Emblem
• Duration: Jan-2016 to Dec-2017
   
• Company: UST Global
• Designation: Process Analyst
• Domain: US Healthcare domain
• Auto Adjudication
• Project : Anthem
• Duration: Nov-2018 to Jul-2020
  
  Company: Firstsource
• Designation: Senior Process Analyst 
• Domain: US Healthcare domain
• Claims Adjudication
• Project : Anthem & Legato Claims

Duration: Jun-2021 to Jan-2022

Professional Experience:                                                                                     

• Process of Claims Adjudication which is responsible for Paying , Denying and Routing the bills.
• Processing the Mainframe Application[WGS] to Finalized the Transaction amount (US Dollar) to Provider.
• Have hands on experience in Claim Adjudication, Duplicates
• Hands on experience in Adjustment Claims.
• Very sound knowledge of claims processing and medical terminology.
• Processing complex cases that require special handling..
• Adaptive to any situations and ability to work in a team.
• Working for Enterprise Benefit Administration for US HealthCare part of Health BPO
• Handling a Sub process under a team. Trained on Benefit coding, Good knowledge Auto Adjudication (End to endprocess).
• Working experience in New group, Change request ,Renewal
• Adding Benefit and benefit changes Coverage plan
• Knowledge in Manual Adjudication and Auto Adjudication.
• Entitling the different types of applications in ‘Citrix Application’ system across USA.
• Attending weekly quality calls and discussing errors and updates with clients
• Extend my duties for the project needed
• Ability to work under pressure of deadline.
  Tool are handle:CMA,WPD,JIRA,WGS,CIW,BLUE SQUARE,WCF,QCARE,BUSINESS OBJECT,DCN KIOSK

Certified Course:                                                                                               

• ACMC-Advanced Certification in Medical Coding (May 2018 to Oct 2018).
  EDUCATION
  Thiruthangal nadar college(Madras university)-BCA-2015year of passing-60%
  Velankanni matriculation higher secondary school(Matriculation)-HSC=2011year of passing-59%
  Muthialpet higher secondary school(State Board)-SSLC-2009year of passing