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Customer Service Medical Claims

Location:
Ibo, 6016, Philippines
Salary:
25,000
Posted:
January 09, 2024

Contact this candidate

Resume:

Name: Mrs. Juliet A. Ventura

Address: Purok Lubi, Yati, Lilo-an, Cebu

Mobile No: +63-929-***-****

Email Address: ad2ktx@r.postjobfree.com

OBJECTIVE:

To be affiliated in a progressive, fast-paced and multidisciplinary company. To practice and improve my leadership, analytical, communication and interpersonal skills and competencies for personal growth and development.

EMPLOYMENT BACKGROUND:

Operations Executive

July 2012 to March 2014

Greenshield Insurance Brokers

Emaar Boulevard Plaza 1, Downtown Dubai, P.O. Box 43656, Dubai, United Arab Emirates

Tel No. +971-*-***-****

Duties and Responsibilites:

Determining insurance coverage through studying provisions of policies.

Maintaining quality customer service by following customer service practices.

Examining and resolving medical claims by approving or denying documentations; calculating benefit due, initiating payment or composing denial letter.

Documenting medical claims by completing forms, reports and records.

Ensuring legal compliance by following company policies, procedures, guidelines as well as government insurance regulations.

Provides legal support by assembling documentation for settlement action

Protects operations by keeping claims information confidential

Admin Assistant - Receptionist cum Secretary cum Insurance Coordinator

April 14, 2007 to April 14, 2012

Smilecare Medical Center

Al Taa’wun Mall, P.O. Box 38987, Sharjah, UAE

Reception Management:

Open and close the dental clinic as per clinic working hours (9am -1pm & 4pm – 9pm).

Plan and schedule the appointments for all doctors in the clinic.

Check the daily schedule and prepare the files accordingly.

Answer and respond to telephone calls with professionalism.

Review supplies for reception and provide order to Medical Director.

Patient Management:

Maintain a professional reception area, keep the facility neat and clean.

Greet and welcome patients and visitors to the clinic.

Check in patients according to the clinic protocol; verify and update health information.

Confirm the next day’s appointment on telephone.

Schedule patients for effective use of doctor and staff time.

Make follow-up appointments as advised by the doctor.

Records Management:

Gather and accurately record dental, medical and insurance information from patients.

Patient record to be stored securely and accurately.

Arrange patient files for the next day’s appointment.

Insurance:

Update insurance information on all patients at all times.

Submit treatment plans for predetermination of benefits.

Prepare claim forms and re-imbursement forms for patients with dental insurance.

Organize all insurance forms and documents necessary for submission to insurance for recovery.

Arrange all documents as required by insurance company for re-submission in case of any rejections.

Maintain claim forms.

Assist in the resolution of any concerns with insurance/ TPA companies.

Attend any insurance orientations, trainings and meetings.

Accounts/Billing:

Prepare bills for patients and collect the payment once the service availed.

Billing of insurance patients.

Maintain and manage petty cash.

Releasing cheque and payment to suppliers.

Prepare daily, monthly and annual sales reports

Doctors reports

Correspondence:

Sort, organize and distribute mail.

Schedule monthly meetings, share minutes of the meetings

College Secretary / Receptionist

February 15, 2006 – March 6, 2007

Cebu Doctors’ University- College of Allied Medical Sciences

Osmeña Boulevard, Cebu City, Philippines

Receives incoming and outgoing calls and take down notes of the received message

Relays the message received to the person concern

Filing and sorting of documents

Handles the enrolment of the students

Prepares the monthly and annual reports of the college

Caters/handles the student’s need

Entertains the visitors/parents’ inquiries for new students applications

Takes charge of the dean’s and department heads schedules

Manages office supplies and equipments

In-charge of the petty cash of the college

Production Worker/Sewer

November 10, 2005 – February 10, 2006

AZP Izumi Philippines

Mepz1, Pusok, Lapu-lapu City, Philippines

Sews quality steering wheel for cars

Electronic Data Processing (EDP) Staff

November 2004 – March 2005

University of Cebu – Maritime Education and Training Center

Alumnos Mambaling, Cebu City, Philippines

Assists in the enrolment of the students

Manages the instructors’ schedule

Store Marketing Assistant (SMART)/ Service Crew

April 15, 2003 – October 15, 2003

Golden Lion Foods Corporation (Jollibee Consolacion)

Consolacion, Cebu, Philippines

Introduces Special promotions and goodies to customers

Sales and Inventory Monitoring

In charge of telemarketing

Manages the bulk orders made by the customers

Handles kiddie parties

Prepares daily and monthly sales reports

Fill-in other departments whenever other service crews are not around

Capable of handling cashier’s work as well as counter partner

Caters the needs of the customers

SEMINAR ATTENDED:

February 18, 2005 “Work Ethics and Professionalism” Univ. of Cebu – Main Campus

February 2005 “Job Hunting & Free Employ't Seminar” Univ. of Cebu – Function Room

April 29, 2006 “Attaining Job Satisfaction White Sands Beach Resort,

Through Positive Work Attitude” Mactan Island, Lapu-lapu City

PERSONAL INFORMATION:

Sex

Female

Date of Birth

July 11, 1984

Place of Birth

Cebu, Philippines

Nationality

Filipino

Status

Married

Address

Purok Lubi, Yati, Lilo-an, Cebu

EDUCATIONAL ATTAINMENT:

Course (graduate)

: Bachelor of Science in Information Technology

: University of Cebu

: Sanciangko Street, Cebu City

: 2001-2005

Secondary (graduate)

: Tayud National High School

: Tayud, Consolacion, Cebu

: 1997-2001

Primary (graduate)

: Yati Elementary School

: Yati, Lilo-an, Cebu, Philippines

: 1991- 1997



Contact this candidate