Fairoz Khan Email & Phone Number

Bengaluru, Karnataka, India

As a Senior Process Consultant in healthcare, I specialize in managing grievances and ensuring compliance to uphold the highest standards of customer service and regulatory adherence. My primary responsibilities include:Grievance Management: Handling and resolving customer complaints with a focus on efficiency and empathy. I work to identify the root causes of issues and implement corrective actions to enhance overall customer satisfaction.Compliance Oversight: Ensuring that all processes adhere to relevant healthcare regulations and standards. I monitor compliance across various departments and address major issues by routing them to the appropriate teams for expedited resolution.Customer Advocacy: Acting as a liaison between the customer and the organization to ensure their needs are met with the highest level of care and attention. My role involves advocating for customers and ensuring their grievances are addressed in a timely and satisfactory manner.

Bengaluru, Karnataka, India

During my time at Rubixe—AI Solutions Company, I had the privilege to collaborate with a dynamic team of professionals, working on cutting-edge data science projects that made a significant impact in various domains. From harnessing the power of machine learning algorithms to deriving actionable insights from complex datasets, every day brought new challenges and opportunities for innovation.My journey at Rubixe—AI Solutions Company has been nothing short of enriching. It allowed me to hone my skills in data analysis, predictive modeling, and statistical inference while contributing to real-world solutions that drive business growth and optimization.

Bengaluru, Karnataka, India

As a Process Consultant in the Healthcare department at Hinduja Global Solutions, I am responsible for managing and resolving member claims related to denied payments. My role involves a comprehensive review and verification process to ensure accurate and fair decisions on appeals. Key responsibilities include:Claims Management: Handling member requests for payment on claims that have been denied. This involves a thorough review of the denied claim to assess the validity of the appeal.Detailed Review: Analyzing detailed claim information, including reviewing necessary documents such as Explanation of Coverage (EOC), CGX, Customer Relationship Management (CRM) records, and Claims Administration System (CAS) data.Verification: Ensuring all medical and diagnostic codes related to the claim are accurate and align with the healthcare services provided. This includes cross-referencing codes and documentation to verify the legitimacy of the claim.Decision Making: Based on the comprehensive review, making informed decisions regarding the payment of the disputed amount. This involves evaluating the evidence to determine if the claim should be upheld or if the initial denial should be revised.Compliance and Process Improvement: Adhering to all relevant healthcare regulations and internal policies. Continuously assessing and improving claim processing procedures to enhance efficiency and accuracy in handling claims.

Bsc, Electronics | Computer Science | Mathematics, Cumulative Gpa Of 6.9

Activities and Societies: National Cadet Corps (NCC): Actively participated in NCC during college days, holding a C Certificate which.

Pre University College, Physics , Chemistry , Mathematics And Electronics, First Class

I completed my Pre-University Course (PUC) with a focus on Physics, Chemistry, Mathematics, and Electronics. This foundational education.