Been a stay at home mom for my 1 yr since last year. It was a role I thoroughly enjoyed. Looking forward to get back to working with my healthcare clients.

QNXT 5.8 version configuration experience.

· Strong experience of TriZetto and QNXT claim engines. · Health Administration – Experience in Claims processing (auto adjudication), COB, EOB, enrollment, EDI, HIX, HMO, PPO, POS, MMIS, Medicare and Medicaid.· Knowledge of healthcare standards such as HIPAA and ICD-10 codes. *· Demonstrated ability to master variety of policy parameters and state requirements

· Research and analyze urgent cases as per CMS guidelines in the third-party government inquiry control software’s.· Collaborate with Supervisor, SME’s and team lead to find the best approaches to address the client’s requirements.· Understand and navigate through HICS systems to change, modify and filter data extracts, also upload casework resolutions. · Managed and maintained streamline of inventory of incoming and outgoing complaints from CMS. · Responsible for tracking and escalating incomplete issues to closure.· Ensure adherence to methods and standards to maintain 95% quality of cases.