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Assistant Manager

Location:
Lake Forest, CA
Posted:
February 19, 2020

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Resume:

#*** **** ***.* ****** 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



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