Jithin Johns
Scarborough,ON
Summary
Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Claims Specialist
SCM Insurance Services
11.2021 - 11.2023
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
Claims Adjudicator
World Financial Group Wfg
09.2020 - 11.2021
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Reduced errors in claims adjudication through diligent review of policies and thorough investigation of claims.
- Managed a caseload of complex claims, ensuring proper handling and timely resolution for optimal outcomes.
- Collaborated with other departments to ensure seamless coordination for effective claim resolutions.
- Supported team members in resolving challenging cases, sharing expertise to foster professional growth among colleagues.
Health Claims Specialist
Halifax Spine Care Center
06.2017 - 12.2019
- Reduced claim processing time by implementing efficient workflow processes and organization strategies.
- Enhanced accuracy in claim submission for better reimbursement rates by thorough reviewing of insurance policies and patient information.
- Collaborated with healthcare providers to obtain necessary documentation, ensuring timely and accurate claim submissions.
- Accurately coded medical diagnoses and procedures using standardized coding systems, ensuring proper reimbursement for healthcare providers.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Responded to correspondence from insurance companies.
- Processed insurance payments and maintained accurate documentation of payments.
- Generated reports on medical claims processing activities and results.
- Maintained confidentiality of patient finances, records, and health statuses.
Operational Manager
Guidehouse
04.2011 - 02.2017
- Streamlined operational processes by implementing efficiency improvements and reducing waste.
- Improved team productivity through effective communication, training, and performance evaluations.
- Managed budgets for multiple projects, ensuring timely delivery and cost control.
- Increased customer satisfaction with consistent quality control measures and proactive issue resolution.
- Implemented innovative solutions to address operational challenges, leading to increased efficiency and reduced costs.
- Developed strong relationships with vendors, resulting in better pricing negotiations and improved service levels.
- Collaborated with executive leadership to develop strategic plans aimed at achieving long-term organizational growth and success.
- Successfully managed change initiatives by effectively communicating expectations clearly among affected individuals or groups.
Education
Master of Science - Biochemistry
Malankara Catholic College
Kerala, India04.2010
Skills
- Coverage Assessments
- Documentation Review
- Compliance Management
- Accident Investigations
- Conflict Resolution
- Claims Investigation
- Customer Service
- Decision Making
- Insurance Knowledge
- Microsoft Office
- Fraud Detection
- Case Management
- Claims Processing
Accomplishments
Best Team Leader Award, 2016, Guidehouse.
Languages
English
Full Professional
Hindi
Native or Bilingual
Tamil
Full Professional
Certification
Certified Professioanl Coder (AAPC)
Certified Coding Specialist (AHIMA)
Timeline
Claims Specialist
SCM Insurance Services
11.2021 - 11.2023
Claims Adjudicator
World Financial Group Wfg
09.2020 - 11.2021
Health Claims Specialist
Halifax Spine Care Center
06.2017 - 12.2019
Operational Manager
Guidehouse
04.2011 - 02.2017
Master of Science - Biochemistry
Malankara Catholic College
Certified Professioanl Coder (AAPC)
Certified Coding Specialist (AHIMA)
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