my updated cv 2017
Post on 08-Feb-2017
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Birthday: May 5, 1988 Mobile: +971 56 420 5798 Address: Al Rigga, Deira, Dubai, UAE Email Address: email@example.com
To extend my expertise in delivering professional customer service and administrative functions in an excellence-centered organization that promotes mutual growth COMPETENCIES:
Seasoned provider of world-class customer service: Senior Front-line
Agent Insurance specialist with more than 2 years of working experience
as a Medical Care Center and Claims Assessor for NEXtCARE Claims Management LLC previously Arab Gulf Health Services.
Delivers unparalleled customer service with the observance of client care proficiencies.
Ability to work with confidential material and maintain confidentiality along with sensitivity to employees and customers needs and data.
Recommended for strong organizational, technical and interpersonal skills.
Proficient analytical skills. Excellent Communication Skills Strong time management abilities.
TECHNICAL SKILLS INCLUDE USE OF: Office programs, knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
JOSEPHVICTORG.TIUSenior Service Account Executive/Claims Specialist
NEXtCARE Claims Management LLC Dubai, U.A.E
Customer Service Representative/Medical Claims Assessor May 2014 Present
Provides verbal and written outpatient procedures pre-approval to providers in UAE and within GCC.
Assess pre-authorization requests from providers/pharmacies Follow communication/update expectations with clients, in accordance with the
NEXtCARE policies, scheme or agreed time frames set. Validates information on all medical claims received. Claims must be thoroughly
reviewed and ensure that there is no missing or incomplete information. Facilitates reimbursement claims and inquiries Corresponds with Call Center Supervisor and Call Center Manager accordingly. Review claims and determine the reason of the claim, process claims according to
processing policies and contract provisions Analyze request as per the Table of Benefits of the Insurance Companies. Assist complaints and look for resolutions as part of problem solving skills. Escalate urgent cases and complaints accordingly Assist the Team Leaders and Handle the Team for follow-ups as per instructions. Take over escalated concern such as Supervisor/Manager calls Train new agents on board with the system and policies terms and conditions. Communicate with Payers under NEXtCARE for clarification and escalation. Maintain best practices and standards
Special Account/Client: United Healthcare Global Solutions (fronted by ASNIC) Service Account Executive/Consultant
Professionally manage Inbound and Outbound telephone and email correspondence with VIP members, providers and all interested parties
Assess and Adjudicate pre-authorization such as outpatient and pharmacy claims Directly coordinate with Al Sagr National Insurance Company/UHC Global for
appropriate escalation of unresolved claims, complaints and high cost claims Complete eligibility verification, determine coverage and identify discrepancies Compliance to international privacy and procedures to deliver excellent customer service
to VIP members and all parties
The Results Companies
WELLCARE Senior Customer Service Associate/Subject Matter Expert/Mentor September 2010 December 2013 Manila, Philippines
Handled calls from healthcare professionals inquiring about patients insurance information
Serves as a mediator between claim processors and healthcare professionals regarding disputing about how payment was made on patients insurance
Provide a complete eligibility and benefit information of the insurance to members and providers
Take over escalated issue such as supervisor or manager call Assist Team Leader in handling the team and coach co-agent under the
Performance Improvement Program Remedios Trinidad Romualdez Medical Foundation Tacloban City, Philippines Bachelor of Science in Nursing (2009) Professional Regulation Commission (Registered Nurse) Nursing Centre for Clinical Laboratory Experience: Basic Cardiac Life Support Alicia Bayoneto Supervisor (Care Center) - 056 408 9706 Jerome Pascual Senior Team Leader (Care Center) - 056 114 4397 Chibuike Ulonnam Team Leader (Care Center) - 055 890 4470
TRAINING AND EDUCATION