Sri Laxmi Manasa Penmetsa

Managing and evaluating international insurance claims. It includes reviewing , investigating, and assessing claims for validity and ensuring compliance with international insurance regulations and policies. This role involves effective communication, negotiation, and compliance with laws while collaborating with various stakeholders to achieve fair and timely claim resolutions.

• Utilization of Electronic Health Records (EHR) systems like EPIC and Meditech on a daily basis to evaluate and manage healthcare treatment and services. They access patient records, review medical history, treatment plans, and procedures recorded in these EHRs. This technology allows them to efficiently assess the quality and necessity of medical care, ensuring it aligns with established standards and guidelines. The utilization of EPIC and Meditech streamlines the review process and supports data-driven decision-making for optimizing patient care and controlling healthcare costs.

Assess claims accuracy, adherence to policy terms, and medical necessity. This role involves reviewing medical records, bills, and reports, making clinical decisions based on medical expertise, ensuring compliance with regulations, and communicating with healthcare providers and policyholders. Medical Reviewers maintain detailed records, stay updated on medical advancements and insurance regulations, prepare reports, and contribute to policy development. Their work is essential for processing claims accurately and fairly, upholding the integrity of the insurance system, and ensuring policyholders receive appropriate benefits for their medical treatments.