Evelyn Sulit

Ensuring all premium collections are chased and updated and to up keep 100% policy renewals and retentions for individual accounts.
Policy Administration January 2016 up to present
•Process individual and group healthcare accounts from receipt of application and/or policy renewal to policy documents issuance including DHPO enrolment. Review individual and group healthcare accounts for missing information and to take appropriate action. Review individual and group healthcare accounts for terms requiring referral to underwriting and include health load in processing of the policy
•Negotiate discount and retention related concern procedures for the member to renew their plan.
•Process, amend and issue documents relating to individual and group healthcare accounts such as but not limited to DHA Claims loss ratio analysis, insurance letter, continuation certificate, JAFZA Certificates, invoices, credit notes. Updates each statement of accounts for all the handled groups.
•Generate tax invoice and sends out UPR invoice. Ensuring all VAT amount are collected in timely fashion.
•Deal with enquiries from existing and potential clients relating to policy benefits and administration guidelines.
•Provides indicative rates and health quotation for existing and new business clients.
•Coordinate with TPA for group policy suspension due to default payment.
•Updates, monitor and provides Policy administration team’s monthly report presentation i.e payment collected vs due, TAT vs SLA.
•Generate and provides TPA individual underwriting health loading and policy eligibility criteria for handled accounts.
•Bookkeeping and maintenance of each account in relation to financial transactions for each policy endorsements.
•Reconcile with client’s Account/Finance representative for invoicing, payments, collections and adjustments
•Chasing non-payment of premium and advises policy suspension or cancellation as per policy compliance

Job Description:
Ensuring all escalation of case managements are addressed and resolved including but not limited to coordination with the underwriting, clients and brokers. Keeping SLAs and resolve claims reimbursement, direct billing and approvals dispute.
Claims Management April 2013 - December 2015
•Generation, preparation and submission of mandated DHA Claims report for loss ratio analysis.
•Advising clients in relation to insurance policy cover, medical claims procedures and generally guiding the client through the claims process.
•Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process
•Ensures that an image of competence and empathy is presented, whilst maintaining technical discipline in relation to the application of policy terms and conditions.
•Undertakes further enquiries with clients, treatment providers, family doctors and other parties, to enable accurate assessment of coverage, ensuring compliance with confidentiality requirements.
•Identifies and reports possible claim overpayments, underpayments and any other irregularities.
•Establishes previous medical history by coordinating with treating doctors and evaluates medical records.
•Processes payments to clients and medical service providers and to other suppliers of services, where appropriate.
•Review and assess processing for contested claims either by inappropriate assessment or ex-gratia base payment.
•Audits TPA handled claims for recoveries, claims management irregularities and discrepancy.

Purpose:
Serves Aon Middle East clients by analyzing, processing and negotiating their claims with the underwriters according to the agreed timelines and service level agreements. Have full ownership and act on behalf of the client to resolve any product and service information and queries.
Duties:
•Takes responsibility for claims and service queries, both written and verbal.
•Inspecting and scrutinizing all received claim documents.
•Monitoring claims behaviors by maintaining:
•An excellent data entry log and diary system with MS Excel registry.
•Daily monitoring of last day activities
•Maintaining the communications of a weekly report communicated with the management
•Continuous and timely fashions follow-up with the underwriters for claims settlement.
•Develop and maintain excellent interpersonal relationships with clients, providers’ network and underwriters.
•Liaise with clients and providers network to obtain necessary medical information needed to process pending claims.
•Continually work to improve current department processes and procedures.
•Resolves product or service problems by clarifying the customer’s complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution.
•Coordinate with the department head, account managers, and executives
Scope of Work
•Claims handling and monitoring via MS Excel registry
•Customer Servicing
•Claims Conflict and Resolution
•Pre-Approvals / Pre-Authorization for In-patient and day-case treatments/procedures.
Team Contribution
•Day to day execution of work volume and claims management in efficient and professional manner.
•Author of the Medical Claims Process manual.
•Administrator of yearly Claims Registry for the Claims Team.

Achievement:
Meet client satisfaction by providing timely preparation and delivery of client demand with accuracy and efficiency. Support managers with documentation archive and report management.

Achievement:
Handled both Hong Kong and Philippine operations for sales and management with constant travel to meet client and suppliers. Prepares franchisee contracts and deliver the training for franchisee staffs. Reaches sales target and up keep client satisfaction. Performs over-all employee performance appraisal and provide market-competitive benefits

CMG OF AUSTRALIA
Insurance Sales Agent
Achievement:
Passed the professional Life Insurance examination given by the Philippines Life Insurance Authority. Reached sales target and maintained client relationship.

Achievement:
Member of the pioneer employees who organized the general office administration guidelines, proper documentation handling and setting up of the standard company policy. I was the Team leader in the inventory management and conduct the technical training within the group. I wrote the team’s policy manual for ISO certification.