Pankaj Kumar Ray

Background

About Pankaj Kumar Ray

I worked as a subject matter expert in Disability and claims team for US insurance benefit. I worked in multiple queues like LTD, STD, Life, Dental, Vision, etc, medical report, Waiver of premium and insurance benefits. I used to receive multiple scan copy of claims and Emails where I needed to review, validate member information, illness, Death record, pregnancy, Denial claims, age over 60 or below, status of claim, return to work date, calculate premium Annual, Monthly, etc. & filling multiple physicians forms and sent to Drs. along with physician forms and also filled PFM form online portal on the basis of premium & provided benefit waiver of premium for Life, LTD and STD benefit. Some of the scenario i needed to crate follow up for premium, denial claims, return to work or not after getting response needed to work and sent to Drs. Earlier, I worked in underwriting process. Where, I was responsible for reviewing insurance application and endorsements to evaluate submitted information required to accept or reject new police based on underwriting guidelines. Assess risk quality for an in-force book of business through a renewal review process to ensure compliance within company guidelines and initiate appropriate loss prevention actions. I created the opportunities on the basis of member salary, age, illness, smoking, non-smoking and total employees in an organization (Large and short market) as per company guidelines and checking their eligibility. I also worked in CEPS (Benefit Administration or Enrolment & Billing) process. I have good knowledge of US health & welfare domain – Health plans, Coverage eligibility, life insurance, open enrolment, EOI, COBRA, Direct billing & payment, annual enrolment and provided waiver of premium for the LTD & STD as per eligibility. I was responsible for Financial & Non-Financial changes - Enrolling members, spouse, newborn baby, etc, change of address & providing requested insurance benefit, decline, activate and terminate benefit like - Dental, Vision, STD, LTD, Life, Cancer, FMLA, COBRA, hospital indemnity insurance, etc. I needed to reach out CM, and employer for missing information through emails, teams or calls. After getting response i needed provide insurance benefits and update computer system as well.