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Medical Claims Processor

Location:
AZ, United Arab Emirates
Salary:
6000 AED
Posted:
June 01, 2015

Contact this candidate

Resume:

Mark Jonathan D. Navarro

*** *** *** ****** ***. Electra St. Abu Dhabi UAE

+971***-***-****

acpxxh@r.postjobfree.com

Summary of Qualifications

Hardworking, focus, can easily adapt to new environment, and a competent graduate of

Bachelor of Science in nursing degree. With less than 2 years experience in data entry and

medical claim processing. Knowledgeable in CPT codes (ICD-9 & ICD10) systems. I have more

than 3 years’ experience in sales/marketing dealing with medical allied professionals,

pharmacies, distributors, have skills in basic marketing, pharmaceuticals sales, and have very

good communication skills, good client servicing skills, self-motivated, honest, and reliable.

Professional Employment

FSI Agency – Daman National Health Insurance (September 2013 up to present)

Al Khaleej Al Arabi Street – Abu Dhabi

Medical Claims Processor

Key Responsibilities:

Evaluate medical necessity and consistency of diagnosis, procedure, drug codes and

description in the claims according to accepted medical coding rules and guidelines while

processing claims on expected daily target with quality and other key performance indicator.

Insure accurate application of contractual prices and discounts, schedule of benefits,

correct allocation of benefits, collection of deductibles, co-payments, observance of policy

limits, and adherence to claims submission protocols.

Processes customer and account source documents by reviewing data for deficiencies;

resolving discrepancies by using standard procedures or returning incomplete documents to

the team leader for resolution.

Proficient in submission, resubmission of claims electronically (E-claim) or manually

(Paper Claim.

Escalate observations about provider’s trend to supervisor in order to improve the

quality of provider’s claims.

Experienced in data entry, processing international claims provider (Outside UAE),

processing claims within Abu Dhabi and Dubai + Northern Emirates providers.

Am-Euro Pharma Corporation (2011-2013)

Sure Choice Marketing

Alabang, Muntinlupa City, Philippines

Medical Sales Representative

Key Responsibilities:

1. Sell company's products, which include medicines, and prescription drugs, to a variety of

customers including general practioner, hospitals and pharmacies.

2. We are usually based in a specific geographical location and specialize in a particular

product or medical area.

3. We also make presentations and organize group events for healthcare professionals, as

well as working with contacts on a one-to-one basis.

4. Arranging appointments with doctors, pharmacists and hospital medical teams, which

may include pre-arranged appointments or regular 'cold' calling;

5. Making presentations to doctors, practice staff and nurses in GP surgeries, hospital

doctors and pharmacists in the retail sector. Presentations may take place in medical

settings during the day, or may be conducted in the evenings at a local hotel or

conference venue;

6. Organizing conferences for doctors and other medical staff;

7. Building and maintaining positive working relationships with medical staff and

supporting administrative staff;

8. Managing budgets (for catering, outside speakers, conferences, hospitality, etc.);

9. Keeping detailed records of all contacts;

10. Reaching (and if possible exceeding) annual sales targets;

11. Planning work schedules and weekly and monthly timetables. This may involve working

with the area sales team or discussing future targets with the area sales manager.

Generally, medical sales executives have their own regional area of responsibility and

plan how and when to target health professions;

12. Regularly attending company meetings, technical data presentations and briefings;

13. Keeping up-to-date with the latest clinical data supplied by the company, and

interpreting, presenting and discussing this data with health professionals during

presentations;

14. Monitoring competitor activity and competitors' products;

Zuellig Pharma Corporation (2010-2011)

Malugay Street. Sen.Gil Puyat Ave, 1265

Makati City, Philippines

Medical Representative

1. Creating a demand for Orthopedic and Health Care Product.

2. Sell the medical products to medical stores, wholesalers and distributors,

concession stores and group of merchandisers.

3. Arrange and represent trade reviews for main accounts.

4. Expands and control both fresh and existing accounts.

5. Achieving targets and sales quotas consistently.

6. Study and recommend alternative to clients.

7. Build sales and latest allotment contest for major distributors and

wholesalers.

8. Generate advertising brochures for distributors’ and wholesalers’ sales

representatives to develop competences and sales.

InnoMed System, Inc (2010)

Unit 208 Continental Court Building

47 Annapolis Street Greenhills, San Juan

Metro Manila, Philippines

Medical Clinician

1. Conducting health education program and giving medical information to the patients

regarding Cardiovascular problems, treatment and prevention.

2. Work as counter-part of medical representatives as company’s strategy to promote the

department (CARDIO) and its product.

Health and Wealth Marketing Services (2010)

Makati City, Philippines

Account Executive

Key Responsibilities:

1. Sell various types of insurance policies to businesses and individuals on behalf of

insurance companies, including medical and dental insurance. Perform administrative

tasks, such as maintaining records and handling policy renewals.

2. Develop marketing strategies to compete with other individuals or companies who sell

insurance.

3. Attend meetings, seminars and programs to learn about new products and services, learn

new skills, and receive technical assistance in developing new accounts.

4. Customize insurance programs to suit individual customers, often covering a variety of

risks.

Sultan Review Group (2009)

Sampaloc, Manila, Philippines

Marketing Staff, Review Adviser, Property Custodian

Key Responsibilities:

1. Gather information and data to compile a list of potential students/customers as target

marketing.

2. Checking of exams and attendance.

3. Prepare activity reports and evaluation of the achievement of Branch Offices regular

monthly.

4. Repair and maintenance of computer in the office.

Datapoint Contact Solution (2009)

Cabanatuan City, Philippines

Chat support (Sales Representative)

Key Responsibilities:

1. Interact with customers to provide and process information in response to inquiries,

concerns, and requests about products and services. (Online games)

Other Skills:

Computer literate in Microsoft Office, Excel, Word, Publisher, and PowerPoint.

Adobe Applications (Photoshop/Illustrator/After Effects)

Education

Wesleyan University-Philippines

Bachelor degree

o

Bachelor of Science in Nursing

2006-2010 (Completed)

Personal Information

Filipino Married, 25 years old, born November 18, 1989, currently employed at First Select

International agency, trustworthy, hardworking, physically & mentally healthy, can join

immediately if necessary.

CHARACTER REFERENCES: Available upon request.

I hereby certify that above record and information is true and correct to the best of my

knowledge and belief.

Mark Jonathan D. Navarro



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