At Inhealth, I analyze and adjudicate more than 3,000 medical claims each month, maintaining a decision accuracy rate of 98%–100%. I review medical records, invoices, and supporting documents against policy provisions.
I investigate potential fraud and claims discrepancies with the anti-fraud team. My work has included identifying repeated dental procedures that led to the discovery of billing fraud at five dental clinics.
I also negotiate bill settlements with healthcare providers and prepare case documentation for escalation, management review, and compliance reporting. I work with legal counsel and clinical experts to resolve claims disputes.
My nursing background informs how I assess diagnoses and medical histories alongside insurance benefits and limits. I use claims analytics to support management decisions and maintain compliance with regulatory requirements.
