MOHAMMED AHMED

CLAIMS REPRESENTATIVE

Address: 12-11-955/A/1, Warasiguda

Secunderabad, Hyderabad

Telangana-500061, INDIA

Email: [email protected]

Phone:+91-7799615912 (Personal)

+91-9440155971 (Home)

EXECUTIVE SUMMARY
04 years of experience in the field of Health Care (Claims) as a Claims representative/Claims examiner.

Working with Top MNC i.e.: United Health Group (OPTUM)-U.S.A,Site (Hyderabad-INDIA).

Received Star Award’s x2 for Best Performance from OPTUM-UHG (Hyderabad-INDIA)

Received Venus Award’s x3 for Best Performance from OPTUM-UHG (Hyderabad-INDIA)

Proficiency in English Language, Strong communication with the team.

Completed M.B.A from Osmania University (O.U) – Hyderabad, INDIA

PERSONAL DETAILS

Full Name                            :               Mohammed Ahmed

Date of Birth/Age            :               20-07-1994

Gender                                                :               Male

Languages Known           :               English, Hindi, Urdu & Telugu

Nationality                          :               Indian

EDUCATIONAL QUALIFICATIONS
(MBA)                                   Osmania University                                         INDIA
FINANCE MARKETING

(B.COM)                              Osmania University                                         INDIA

COMMERCE

(HSE)                                     Board of Intermediate                                   INDIA

CEC

(SSC)                     Jawahar V.N English High School                               INDIA

SSC

PROJECTS:

Title
Investment in Financial Markets
Company
Invests Leaf Management Solutions
Company
UNITED HEALTH GROUP (OPTUM)

About
UnitedHealth Group is a distinctively diversified health and well-being company headquartered in the United States, and a leader worldwide in helping people live healthier lives and helping make the health system work better for everyone.
Designation
CLAIMS REPRESENTATIVE
Date: Aug 2015 to Present
Location
Hi-Tech City, Hyderabad-INDIA

JOB RESPONSIBILTIES:

·         Process claims, that route out of automatic adjudication, within current turnaround standards.

·         Able to understand and apply plan concepts to include:Deductible,Coinsurance,Copay,Out of pocket

·         Processed claims adjustments when applicable

·         Analyze patient’s records and medical history and maintain the records relating to medical payment.

·         Analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment.

·         Escalated issues or inquires as required.

·         Demonstrate increasing the productivity to meet minimum requirements while maintaining quality standards.

·         Maintained knowledge on policies and procedures of processing on a daily basis.

·         Worked with team members to ensure consistency among all staff in procedures used.

·         Worked with trainers, mentors and managers on streamlining processes when areas for growth are identified

·         Worked with the company systems and completed all assigned tasks, working overtime as needed.

·         Publish production report to the team on daily basis.

PROMOTIONS IN UHG-OPTUM

·         Moved from L1 to L2 stage with in a time period of 14 months.

REFERENCES:

Mr. Syed Wasim, Process Mentor (UNITED HEALTH GROUP-OPTUM) Hyderabad-INDIA.

Mr. Mohd Azhar Uddin, Team Leader (UNITED HEALTH GROUP-OPTUM) Hyderabad-INDIA.

DECLARATION:

I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility for the correctness of the above-mentioned particulars.

(Mohammed Ahmed)

Applicant