#*** **** ***.* ****** Lovebirds St. Countryside Vill. Bgy. Sun Valley Parañaque City
Phone 091********
E-mail adbvfd@r.postjobfree.com
Edwin H. Aguilar
Work experience
April 2017 to Present United Health Group Mckinley
Taguig
Assistant Manager – Recovery Services
Coordinate and supervise daily/weekly/monthly activities of team members
Set priorities for the team to ensure task completion and performance goals are met
Coordinate work activities with other supervisors, managers, departments, etc.
Identify and resolve operational problems using defined processes, expertise and judgment
Provide coaching, feedback and annual performance reviews as well as formal corrective action
April 2016 to April 2018 United Health Group
Operational Trainer – Process ( Recovery Services)
Demonstrate working knowledge of applicable operational platforms (e.g., workflows, procedures, systems) to drive effective training
Demonstrate appropriate teaching method, style and pace to optimize learning, adopting different delivery
Adhere to applicable training requirements (e.g., calendars/timelines, playbooks, agendas, facilitator/participant guides)
Conduct train-the-trainer activities to prepare others for effective facilitation, including providing context/direction
Demonstrate understanding of applicable business structures and strategies
October 2015 to April 2016 United Health Group
Subject Matter Expert (SME) – United Recovery Services
Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
Analyze, identify trends, and provide reports as necessary
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Perform other duties as assigned
July 2012 to October 2015 United Health Group
Sr. Recovery Specialist (United Recovery Services)
Responsible for investigating, recovering and resolving all types of claims for health plans.
Perform research/verification of identified claims to identify payment/overpayment issues/accuracy.
Work with internal and/or external providers to facilitate resolution of overpayments
Communicate overpayment information to payers/providers as appropriate, including explanations of the reasons for overpayment (through outbound calls, letters, emails)
Address concerns/inquiries/appeals from providers
Obtain commitment of provider/other entity to refund, close overpayment, obtain check or offset
Verify/ensure that overpayment/refund checks are properly applied to the appropriate claims/overpayments
Demonstrate understanding of relevant privacy regulations like HIPAA guideline and fair claims practices/laws
Coordination of Benefits (COB)
Responsible for determining which insurance is primary,
secondary or tertiary.
May include initiating telephone calls to members providers and other insurance companies to gather coordination of benefits data.
Sept.(2006) - July 2010 G.E. Money Bank Northgate Alabang
Servicing Phils. Muntinlupa City
Fraud Analyst (All accounts / Portfolio)
Responsible for reporting Lost / Stolen / Compromised credit card
Responsible for reporting unauthorized charges and keep clients’ accounts current.
Customer Service Associate (Credit Account – Sam’s Club and
Wal-mart)
Responsible for answering inbound calls from stores and
Customers regarding all facets of Clients Credit Card.
Resolve credit inquiries on new accounts and authorize sales on
Existing accounts
Make use of problem solving / decision making skills to achieve
The highest level of customer account life cycle satisfaction.
Nov.(2005) – June(2006) Client Logic Emerald Ave. Ortigas
Center Pasig City
Customer Care Representative (Travel Account – Affinion)
Responsible for taking inbound calls from clients in the U.S. regarding flight, car and hotel reservations.
March(2005) – Sept.(2005) APAC Northgate Alabang
Muntinlupa City
Customer Care Representative (Horizon Account)
Responsible for taking inbound calls from Health providers in the U.S. regarding claims and benefits
2003 - 2004 Client Logic Emerald Ave. Ortigas
Center Pasig City
Technical Support Engineer (Dell Computers)
Responsible for taking inbound calls from clients in the U.S.
Regarding computer hardware.
Education
1999 - 2003 DLSU-College of St. Benilde Taft Ave. Manila
BS Business Administration major in Computer Application
1st Place Volleyball Showdown 2000
1st Place volleyball Showdown 2001
1995 – 1999 Ville St. John Academy Marcelo P’que
City
1989 – 1995 South Merville School Merville P’que
City