Jesna B S
Dubai,United Arab Emirates
Summary
Accomplished professional with extensive expertise in medical insurance, billing, and accounting. Demonstrates proficiency in scrutinising medical claims, fraud detection, and abuse detection, ensuring accurate claim settlements and financial reporting. Skilled in utilising CPT codes, ICD-10CM, DC-9CM, HCPS, and DRG codes to optimise claims processing. Adept at quality workflow management and coordination using ESKANEDIA software. Committed to enhancing claims investigation techniques and underwriting principles to improve dispute handling and over-utilisation detection. Career goal: To leverage skills in claims processing software for advancing industry standards in claim investigation and settlement.
Overview
10
10
years of professional experience
4
4
years of post-secondary education
1
1
Certification
Work history
ClaimsOfficer
Ras Al Khaimah National Insurance PJSC
12.2021 - 08.2025
- Supported Medical Claims Manager in overseeing claims processes, ensuring efficiency and compliance.
- Acted as liaison among claims team, healthcare providers, and internal departments.
- Supervised daily operations of medical claims department, reporting directly to Insurance Manager.
- Reviewed complex claims, providing recommendations for approvals based on thorough analysis.
- Verified accuracy of submitted claims and supporting documentation to maintain integrity.
- Liaised with providers and clients for clarifications and resolved disputes efficiently.
- Monitored claims data to identify trends and instances of over-utilisation.
- Trained and mentored claims staff, enhancing overall team performance.
- Liaised with adjusters to expedite claim settlement.
- Analysed complex data to make informed decisions on claims validation.
- Minimised fraud risk through comprehensive assessment of each claim.
- Maintained up-to-date knowledge of insurance regulations to uphold industry standards.
- Coordinated well with various departments, achieving seamless workflow .
- Met strict deadlines by proficiently managing workload.
- Improved claims processing speed by meticulous evaluation of submitted documents.
- Authenticated policyholder information for accurate decision-making process.
- Handled customer complaints for better client satisfaction.
- Negotiated effectively with solicitors regarding disputed claims resolution .
Insurance Officer (Approvals & Submissions)
Dr. Ashish Medical Center
Ajman
01.2021 - 12.2021
- Carrying out consultations with patients to learn their detailed case history.
- Decide on best use of remedies to treat a range of conditions.
- Monitor, track & evaluate patient progress.
- Advice on lifestyle issues, diet, mental health etc.
- Managing clinical notes & records for each patient.
- Research medical conditions & homoeopathic remedies.
- Run seminars, presentations for groups in the community, or other health practitioners, to promote homoeopathy.
- Managing insurance portfolio of patients including submission & approvals.
Insurance Officer Trainee
Al Shams Medical & Diagnostic Center
Sharjah
09.2019 - 04.2020
- Assisting the Insurance Officer for Approvals & Submission activities.
- Hands-on training experience in portals (MEDAS) as well as documentation.
- Monitor claims costs as per internal guidelines.
- Analysis of claim rejection & taking corrective steps.
- Coordination with RCM manager regarding the insurance department activities.
Consultant Homoeopath
The Samagra Homoeopathic Hospital
, India
08.2015 - 12.2018
- Coordinated medical care while supervising functions of other medical personnel.
- Conducted clinical consultations, case evaluations, and physical examinations.
- Prescribed medications according to diagnosis and individual case history.
- Maintained thorough documentation of patient medical histories.
- Guided patients on dietary choices, exercise, and relevant homoeopathic factors.
- Helped patients establish behaviour regimens to promote healthier lifestyles.
- Issued referrals to additional healthcare practitioners when required.
- Collaborated with various departments to facilitate smooth operational processes.
Education
Master's in Psychology -
01.2017 - 12.2017
Bachelor's in Homeopathic Medicine & Surgery - undefined
01.2012 - 12.2012
Certified Professional Coder - undefined
AAPC
01.2019 - 12.2019
Specialized Course in Predictive Homoeopathy - undefined
01.2017 - 12.2017
Skills
- Medical Insurance
- Billing
- Accounting
- Medical Claims Scrutinizing
- Fraud Detection
- Abuse Detection
- Over Utilization Detection
- CPT Codes
- ICD-10CM
- DC-9CM
- HCPS
- DRG Codes
- Communication
- Coordination
- Quality Workflow Management
- ESKANEDIA
- Claim investigation techniques
- Underwriting principles
- Claims processing software
- Dispute handling savvy
- Claims investigation
- Claim settlements
- Financial reporting
Custom
Anjum Elachola, Sr. Medical Claims Manager, Ras Al Khaimah National Insurance PJSC
Certification
Ministry of Health (MOH) - UAE
TCMC - India
Timeline
ClaimsOfficer
Ras Al Khaimah National Insurance PJSC
12.2021 - 08.2025
Insurance Officer (Approvals & Submissions)
Dr. Ashish Medical Center
01.2021 - 12.2021
Insurance Officer Trainee
Al Shams Medical & Diagnostic Center
09.2019 - 04.2020
Certified Professional Coder - undefined
AAPC
01.2019 - 12.2019
Master's in Psychology -
01.2017 - 12.2017
Specialized Course in Predictive Homoeopathy - undefined
01.2017 - 12.2017
Consultant Homoeopath
The Samagra Homoeopathic Hospital
08.2015 - 12.2018
Bachelor's in Homeopathic Medicine & Surgery - undefined
01.2012 - 12.2012
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