Mohanapriya K

* Reviewed P&C insurance documents for compliance with company policies and regulatory requirements.

* Verified supporting documentation before policies, endorsements, certificates and invoices.

* Reviewed and validated Policy Summaries to ensure accuracy, completeness, and compliance with underwriting guidelines.
* Managed Program Tracking by monitoring policy status, renewals, and updated renewal trackers ensuring timely follow-up and renewal processing.
* Prepared, reviewed, and processed Schedule of Insurance (SOI) with a high degree of accuracy.
* Coordinated Policy Delivery, ensuring timely issuance and distribution of policy documents to clients and stakeholders.

• Claims processing and investigation of member claims, ensuring accuracy for dental, vision, and medical claims.
• Handled critical clients to ensure efficiency and high accuracy, avoiding escalations.
• Analyzed and checked member eligibility and benefits, applying them accurately to prevent payment discrepancies.
• Processed prior authorization requests for medical procedures, diagnostic tests, and specialty medications.
• Reviewed clinical documentation to ensure authorization requests met payer guidelines.
• Coordinated with healthcare providers, insurance companies, and members to obtain the required information.
• Managed inbound and outbound member communications regarding authorization status, benefit verification, and pending documentation.
• Experienced with tools such as Eurocare, Globalcare, and Salesforce.

• Managed workload and priorities to meet claims processing meet deadlines.
• Reviewed applications and supporting documents to verify claims eligibility and accuracy.
• Developed and implemented quality assurance processes to check accuracy of claims processing.
• Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
• Monitored claims processing trends to identify potential areas of improvement and took initiative to consolidate production reports of team.