Medical Claims Officer
NAS Administration Services LLC
Total des années d'expérience :14 years, 8 Mois
● Adjudicated and processed paper and e-claims in conformity to policy terms and conditions.
● Assessed and authorized real-time service requests from providers within the set turnaround time.
● Resolved claim adjudication issues and provided prompt response to queries received from clients.
● Provided independent decision making skills and demonstrated initiatives to resolve issues for internal and external clients.
● Provided claims support and settled issues related to claims adjudication, complaints and queries as received over the phone and via mail.
● Extended high quality customer service by responding accurately and efficiently to in-bound calls and mail enquiries.
● Conducted pre-authorization reviews with Medical Officers for high-cost medication and/or service requests.
● Reviewed medical trends, identified fraudulent cases and escalated these to higher management.
● Ensured that assigned goals and tasks are accomplished in a timely manner.
● Consolidated data on external factors such as market dynamics and trends on products and services.
● Collaborated with department leads in merchandising, marketing and field communications to deduce key objectives.
● Assisted the team in developing concepts and molding the brand’s direction.
● Provided English names for skin care products which reflects the Company’s brand and image.
● Helped improve online store’s site navigation, presentation and organization.
● Assisted with inventory, including receiving and stocking merchandise.
● Managed financial transactions, prepared orders and invoices for online store purchases.
● Managed the pharmacy’s daily operations - ensuring safe, accurate and efficient dispensing of
medications.
● Dispensed prescribed medications, food supplements and other pharmaceuticals for quality patient care according to professional standards and state legal requirements governing pharmacy practice.
● Advised customers on selection and proper usage of non-ethical medication, medical equipment and other healthcare supplies.
● Answered questions and provided information to customers on drug interactions, side effects, dosage, mode of administration and proper storage of pharmaceuticals.
● Ensured stock availability, proper handling and storage of pharmaceuticals, medical equipment and supplies.
● Achieved financial results as dictated by the branch budget and minimized loss and breakage.
● Attended and managed regulatory audit inspection conducted by FDA inspectors.
● Supervised the pharmacy staff and resolved any and all personnel issues.
● Facilitated in-store training of newly hired pharmacists and retail internship of pharmacy students.
Bachelor of Science in Pharmacy Registered Pharmacist | August 2004 to Present Professional Regulations Commission, Manila, Philippines