Medical Claims Processor
Resume:
Mark Jonathan D. Navarro
*** *** *** ****** ***. Electra St. Abu Dhabi UAE
*********************@*****.***
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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