Prakash Manoharan Email and Phone Number

Current project - AETNA ·        Verifying US physicians’ background which includes license, professional liability insurance, physician board, language and malpractice details. ·        Supporting the team in updating the tracker, sharing updates in daily huddles weekly fun activities and weekly assessments.·        Gathering the missing information of physician verification through phone calls and emails.·        Maintaining production quality attendance and compliance. Previous project - CIGNA ·        Validating copays, co-insurances, deductibles and accumulators using CBM and Mainframe Systems.·        Generating input/output files using the BTA Automation tool in Q-Core application.·        Researching and completion of end-to-end quality testing in the Polaris application.·        Identifying defects from BBR reports and creating defect management procedures.·        Taking ownership to support the team in clarifying the doubts and rectifying general queries.

·        Owned end-to-end administrative and facility management in Chennai and handled administrative responsibilities in London.·        Worked closely with the management team on all aspects of administration and ensured site functions were handled smoothly.·        Researched, analysed and documented the requirements for each and every project and submitted them to the management within the deadlines. ·        Negotiated contracts with prospective vendors. ·        Coordinated all aspects of the requirements starting from vendor shortlisting, monitoring the work completed and getting approval for payment release upon completion of work.·        Understanding the issues and concerns of the employees on site and implement appropriate and preventive actions to help create a better workplace.·        Handled IT procurement for the site whenever required.

·        Was accountable for the entire audit of the claim completed by my team members. ·        Worked with clients to refund differential amounts identified in the claims.·        Worked on different types of claims including CMS (professional) and UB (instructional) claims. ·        Reviewed hold codes entered by the team and provided appropriate solutions to approve and process the final payment. ·        Was responsible for auditing the work completed by both onshore and offshore team members to maintain the quality standards.·        Owned Root Cause Analysis for the team and analysed the errors by conducting regular individual discussions and brainstorming sessions.·        Conducted weekly quiz/assessments on the updates/errors for the audits completed the previous week.·        Played the role of Team Leader in their absence and took care of task assignment and provided day-to-day support for all essential business requirements. ·        Recognised as a potential SME to help guide new team members to achieve the required quality and productivity. ·        Handled regular client interactions through emails and telephonic calls to address process queries and performance.

·        Provided first level support for handling insurance claims escalated by stakeholders to address any disputes or issues.·        Addressed tickets that were put on hold due to process issues and raise appropriate queries to provide timely solutions.·        Took on the role of a Subject Matter Expert and provided guidance and resolved queries raised by peers.·        Ensured quality parameters devised for various sub-processes were maintained.

·        Reviewed and processed insurance claims received from the clients. ·        Abided by the approved policies and procedures for each file processed to reach the correct decision.·        Researched claim overpayments and requested for reimbursements.  ·        Conducted audit for randomly selected claims to ensure quality processing.·        Provided timely customer services to members, billing departments and other insurance provides to ensure SLAs were adhered.