customer service / medical pre approval
qatar insurance company
Total years of experience :21 years, 10 Months
1. Ensuring the high quality services to the clients.
2. Verify clients table of benefit especially with optional coverage (dental, maternity, optical limit), scope of cover.
3. Respond immediately in pre-approval with the network accredited provider and emails.
4. Answers customer inquiries and communications as required.
5. Constantly communicates with the provider for other clients concern.
6. Checking the claim status of member's for deletion.
7.Performs other related duties as assigned by management.
8. Responsible for call center reports (monthly & quarterly)
9.Conducts follow up discharge calls to survey clients who have concerns or questions, monitoring error log of the staff & complaint log of the customers.
1. Complies with company and department policies and procedures.
2. Facilitate out patient availment
a. Assesses coverage or non coverage of availment (for readily coverable or non- coverable)
b. Issues the referral form
c. Coordinates with different hospital units to facilitate availment whenever necessary.
3. Monitors Confinement
a. Checks daily with Head office on admission by members of assigned
account.
b. Updates client’s HRD on the status of complicated confinement.
c. Coordinates with other Customer Care units and other departments, and hospital providers for pertinent assistance or concerns.
4. Informs and updates client’s HRD on the status of its membership policies, benefits and availments especially those with pending concerns.
5. Assist the collection of payments for account receivables.
6. Facilitates payment for premium and lost ID card fees.
7. Facilitates documents, i.e. application form, claim for reimbursement, lost ID form, Philhealth form, Corporate guarantee memos & other correspondences.
8. Facilitates release of ID cards, ACU result (upon clients request)
checks for reimbursement claim and retainer’s fee and other correspondences from Head office.
9. Constantly communicates with supervisor and/or Head office on pressing issues.
10. Prepares and submits pertinent reports as required by the unit Supervisor.
1. Facilitates Out patient / In patient availment
2. Monitors Out patient / In patient availment
3. Checks daily census on admissions.
4. Encode patient’s data information.
5. Give instruction need to submit by the client on or before discharge date i.e. Philhealth form, LOA, OWWA if any.
6. Encode all walk in ER cases
7. Encode medicines as prescribed by ER doctor to the patient.
8. Verify to HMO department the coverable and un coverable cases (applicable only for all those member with health card)
9. Coordinates with the other departments and hospital for pertinent assistance or concerns.
CLINICAL INTERNSHIP (June 2001 – March 2002) June Saint Claire Medical Center (Makati City) July I-Rehabilitation Center (San Pedro Laguna) August Calamba Doctors Hospital (Calamba City Laguna) September Birthright Educators Foundation (Muntinlupa City) October Saint Claire Medical Center (Makati City) November Clinica Pastor Rehabilitation Medicine December Muscle & Joints Rehabilitation Center (Batangas City) January Muscles & Joints Rehabilitation Center February Pamana Golden Care (Calamba City) March Saint Claire Medical Center (Makati City) Seminars, Trainings and Workshop: CUSTOMER CARE Alexander Language Center Qatar Insurance Company February 21-25, 2010 Global 8Disciplined Approach (Team Oriented Problem Solving) NXP Semiconductors Cabuyao Inc. (Formerly Philips Semiconductors) Cabuyao Laguna July 25, 2007 MAXIFIRST : The Customer Comes Second The Maxicare Frontliner Quality Improvement Program 24th Export Bank Conference Center Gil Puyat Ave. Makati City June 26-28, 2007 Youth Volunteer (Camp-out of the Autism Center) Cahbriba Alternative School Foundation Inc. Autism Center Los Banos Laguna September 21-22, 2000 Career Opportunities for PTs and OTs in the Philippines and in US Saint John and Paul Colleges Calamba City Laguna September 26, 1997