Krishna Kumar Email & Phone Number

Chennai, Tn, In

Chennai, Tamil Nadu, India

Responsible for configuring the health plan's benefit structures in the insurance company's claims processing system. This involves ensuring that the benefits are accurately and consistently set up, and that any changes to the benefit design are reflected in the system including coverage levels, deductibles, copays, coinsurance, and maximum out-of-pocket limitAs a benefit coder at Oscar responsibilities include - Coding and maintaining health insurance benefits and plan designs in the Oscar system.Ensuring that all benefits and plan designs are accurately reflected in the Oscar system and aligned with regulatory requirements.Collaborating with product managers, actuaries, and other stakeholders to ensure that benefit and plan design changes are accurately reflected in the system.Claims Audit: Screens, reviews, evaluate claims based on set audit requirements and shares audit findings for further action, following organizational policies and procedures as part of retrospective quality control review under risk and governance areaReviews processed claims and inquiries to determine corrective action which can include adjusting claimsTakes the corrective action steps using enrollment, benefit, and historical claim processing informationDetermine if the claim information is complete and correct. Enter/verify claims data.Resolve claim edits (suspensions), review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination.Elevates issues to the next level of supervision, as appropriate.Maintains accurate records, including timekeeping records.Conducting quality assurance checks to ensure that benefits and plan designs are functioning correctly in the system.Troubleshooting and resolving issues related to benefit and plan design coding in the Oscar system.Analyzing and interpreting benefit and plan design data to identify trends and make recommendations for improvements.

Chennai, Tamil Nadu, India

Chennai, Tamil Nadu, India