Komal Patil

Senior Process Executive

• Job Details:Reviewed, processed, and validated hospital, medical, and home service claims. Investigated denials, provided justifications, and supported appeals. Ensured adherence to insurance policies, payer guidelines, and regulations. Verified health benefits, configured pricing, and tested health plans. Reviewed claims for accurate coding (ICD-10, CPT, HCPCS). Handled bill reviews, reimbursements, and payment processing. Resolved provider inquiries and explained policy details. Worked with hospitals, clinics, insurers, and internal teams for claim resolution. Assessed claims, medical reports, and policy terms for accuracy. Maintained documentation and updated systems for audit readiness.

Dental Spec Claim Examiner

• Job Details:Managed claims for Canadian policyholders using Ben application in the Canada Life project, ensuring accuracy and timeliness. Reviewed complex dental and health claims for accuracy, completeness, and compliance with adjudication guidelines. Conducted eligibility checks to ensure claims met policy requirements before payment. Applied adjudication rules to authorize and finalize reimbursements for providers and members. Coordinated with dental providers to obtain missing documentation and clarify patient details. Resolved provider and member inquiries on claims status, payments, and policy coverage.