Kishan Pun

Experience

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  WIPRO LTD

  May 2006 - Nov 2009

  CLAIM ANALYST, CLAIM ADJUDICATOR

  • Processing accounting adjustments, conduct analysis of data, identify trends, determine root causes, provide reports as appropriate for claim teams, and ensure quality improvement.• Responsible for processing accounting adjustments .• Identify the nature of the claim error (e.g., incorrect SS#, wrong provider suffix)• Perform all necessary steps related to individual/bulk recovery processes.• Determine corrective action needed based on nature of error and process adjustment. • Reprocess the claim and/or process adjustment correctly as appropriate for the applicable claim processing system.• Take appropriate corrective action (e.g., send additional payment in the event of an underpayment) • Handle all necessary correspondence appropriate for the adjustment/overpayment (e.g., follow-up letters for claim overpayment) • Adhere to quality improvement initiatives .• Analyze data on adjustments, overpayments, and returned checks. Show less

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  Inventurus Knowledge Solutions

  Nov 2009 - Mar 2012

  CLAIM ANALYST

  • Analyzing and correcting the rejected claims from the clearing house.• Denial management. Managing the denied claims and to provide the correct solutions.• Medical claims billing. Analyzing and billing the claims which are on unbilled status.• Accelerating initiation of billing process.• Analyzing ,Resolving and correcting the claim through Claim correction form (CCF) requested by the clinic and rebilling the corrected claim. • Team interaction • MIS report preparations • Process Training – Individual / Group Sessions • Participate in internal audits • Execute correction/ corrective/ preventive actions based on audit observations/ customer feedback.• Adjusting the wrong payment posted in the system and correcting the patient , insurance payment which are not posted correctly. • Analyzing the Patient Eligibility.• Analyzing overall correctness of claims and ensure the correct payment is received from insurance company. Show less

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  SIEMENS HEALTHCARE PRIVATE LIMITED.

  Feb 2012 - now

  Field service management, Customer Service coordinator, Scheduler, Planner, Complaint handler

  • Ensuring to log customer complaints in the system and support customers in resolving customer problems. • Making outbound calls to customers to clearly explain order situations, next steps, and potential outcomes. • Took ownership of enquiries, effectively handling any customer issues to ensure suitable resolutions for customers. Taking Feedback from customer after Engineer visit. • Identify Suitable Field Staff by optimizing availability, location, and Trained engineers and Reviewing routes.•Plan and schedule field service resources for Installations, Preventative Maintenance, and Field Modifications while balancing the urgent needs of a complex customer base for emergencies. • Liaise with customers to fix appointments for PMS, Breakdown, and system updates. Informing customers about changes in plan activities.• Making outbound calls to customers to clearly explain order situations, next steps, and potential outcomes.• Resolve resource conflicts by re-planning of activities within the defined scope. • Took ownership of enquiries, effectively handling any customer issues to ensure suitable resolutions for customers.• Representing Siemens by visiting customer sites to understand customer problems and supporting by furnishing resolution. • Took responsibility for escalating and expediting cases involving out-of-stock parts meeting same-day and next-day delivery for Field Service Engineers.• Navigating contract documents and SAP system for undertaking correct PMS schedule.• liaising with Internal and external customers.• Ensure all ticket jobs are assigned and allocated to technicians as per SLA through periodic checks. • Monitor spare part delivery status: re-plan changes where necessary.Informing customers about changes in the CSE plans. • Coordinate with Logistics to deliver tools and test equipment at required regions and customer addresses. Show less