Sheril Joshi
Supervisor Life & Medical Claims
Summary
Medical Claims Specialist with 11 years of experience in insurance operations and medical claim processing. Proficient in ICD-10, CPT, and HCPCS coding standards, with a strong focus on claim audits and policy servicing. Demonstrated ability to collaborate across functions, ensure compliance, and mentor staff to enhance performance. CPC certified with proven analytical and communication skills.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Supervisor - Medical & Life Claims
National Life and General Insurance Company
11.2022 - Current
- Medical Reimbursement claim processing for Inhouse and TPA coordinated policies
- Oversight of claim posting, auditing and SLA compliance
- Provider claim postings and payment activity
- Daily reimbursement tracker updation and claim postings
- Coordination of Group Life Claim processing in coordination with HO
- Effective communication with TPA and broker / client for claim approvals/ rejections.
- Collaborate with underwriting and legal departments on complex or high value claims.
- Trained staff on claim adjudication, fraud detection and system updates.
- Prepared daily / weekly / monthly claim registers and reports
- Coordinate with TPA for chronic medication posting in system.
- In case of customer/broker/RM concern liaising with TPA for the query resolution
- Individual Medical Policy Issuance
- Issuance of Group Life Policy after verifications in coordination with HO
- Addition and deletion endorsements of Group Life and Group Medical policies.
- Placement of Individual Medical Policy with TPA for creating contract
- Placement of Group medical policy with TPA
- Tracking of Individual medical, Group life and medical policies and following up with RMs/brokers/ clients for annual renewals.
- Verification of AML of each Group Life Policy before issuance. AML Verification in coordination with AML Team.
- Collaborated with underwriting legal and RM teams for policy coordination and renewals.
- Preparing daily/ weekly/ monthly life and medical portfolio.
- Claim processing for the members done within the TAT
Medical Coder
Dar Al Shifa Hospital
01.2017 - 01.2020
- Reviewed electronic medical records, ICD-10, CPT, HCPCS, ICPM & CCHI coding
- Generated discharge indicator reports for MOH submissions
- Tracked KPIs with Quality Department (readmissions, M&M cases, DAMA etc)
- Queried physicians for incomplete or inconsistent documentation
- Updated coding knowledge based on MOH and accreditation requirements
- Contributed to HIMSS Stage 6 & 7 Accreditation
Clinical Instructor
Alia International Hospital
01.2016 - 01.2017
- Delivered practical instruction across medical, surgical, emergency, pediatric, OBG and cardiac wards.
Postgraduate nursing Intern
KVM College of Nursing
01.2014 - 01.2016
- Worked in coronary care, ICU and general medical surgical wards during MSc.
Clinical Instructor
Al Shifa College of Nursing
01.2013 - 01.2014
- Taught Nursing Foundation, Anatomy, Physiology, Psychology
Registered Nurse
Madras Medical Mission
Chennai
01.2012 - 01.2013
- Managed patient care in cardiac surgery ward and pediatric ICU
Education
Certified Professional Coder -
Cigma Medical Coding Academy
Ernakulam, India11.2018
Master of Science - Cardiovascular & Thoracic Nursing
KVM College of Nursing
Kerala, India10.2013
Bachelor of Science -
Pondicherry Institute of Medical Science
Pondicherry, India03.2009
AISSCE -
Kendriya Vidyalaya Port Trust
India03.2004
AISSE -
Kendriya Vidyalaya Port Trust
India03.2002
Skills
- ICD-10
- CPT
- HCPCS
- ICPM
- CCHI
- Medical and life policy underwriting and servicing
- Claims processing and auditing
- MS Excel
- Word
- PowerPoint
- Outlook
- Strong interpersonal and communication skills
- Clinical instruction and presentation skills
- Problem solving and decision making
- Team leadership and staff training
- Regulatory compliance and AML handling
Certification
AAPC – CPC Certified, Active
Accomplishments
- Contributed to HIMSS Stage 6 & 7 Accreditation (Dar Al Shifa Hospital)
- Completed 254 Hours of Medical Coding Training at Cigma Medical Academy
Languages
- English, Fluent
- Hindi, Conversational
- Malayalam, Native
Timeline
Supervisor - Medical & Life Claims
National Life and General Insurance Company
11.2022 - Current
Medical Coder
Dar Al Shifa Hospital
01.2017 - 01.2020
Clinical Instructor
Alia International Hospital
01.2016 - 01.2017
Postgraduate nursing Intern
KVM College of Nursing
01.2014 - 01.2016
Clinical Instructor
Al Shifa College of Nursing
01.2013 - 01.2014
Registered Nurse
Madras Medical Mission
01.2012 - 01.2013
Certified Professional Coder -
Cigma Medical Coding Academy
Master of Science - Cardiovascular & Thoracic Nursing
KVM College of Nursing
Bachelor of Science -
Pondicherry Institute of Medical Science
AISSCE -
Kendriya Vidyalaya Port Trust
AISSE -
Kendriya Vidyalaya Port Trust
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