Fulfillment Officer
Oman Insurance Company
Total years of experience :18 years, 9 Months
Workflow Management - Point of contact and escalation for any new, renewal and endorsement of the policy. Responsible for screening and coordinating with internal and external customers any requirements of a specific policy prior to the processing of the confirmed quotation. Assigns confirmation and identifies prioritization on policies to be issued. Ensures policies are issued within turn around time. Liaise with broker relationship unit, underwriting department, branches, and direct clients for any issues identified during the policy set up.
Technical & Audit - Responsible for regulatory submission of products specifically Health Authority of Abu Dhabi (HAAD) and Dubai Health Association (DHA). Prepares and reviews all documents for internal and external regulatory audits. Performs audit on policy contracts and output of the policy issuance team. Ensures consistency in implementation of medical underwriting processes and guidelines. Identifies process related errors driving to resolve both process and people issues. Maintains quality focus by proactive contribution to Process Improvements and works with Technical Manager and Underwriters to meet efficiency of both the process and team.
Reporting - Manages productivity reports with regard to adherence to unit’s Key Performance Indications as well as management dashboards. Tracks all policy confirmations, requests, queries, complaints & errors received in relation to policy issuance.
Role demands communication, leadership and technical skills to drive both people and process efficiency.
HealthCareSystem (Claims System) Audit (June 2013 - Feb 2014)
Responsible for Claims Rules Setup and User Acceptance Testing. Performs review of benefit packages in claims system as per the agreed benefits of the client for new and renewal policy confirmations. Ensures that all benefits are ruled accordingly in the system for accurate manual and automated claims processing by validating package rules and creating test claims entries. Liaise with IT team to resolve any identified discrepancy between the rules of the system and table of benefits of the policy. Point of contact for claims and IT on any issue encountered related to benefit set up in Claims system. Role demands analytical thinking, drive for resolution and technical understanding of the system as well as the benefits of the policy.
Technical Support Unit Medical Insurance - Manages Renewal and New Business Set up for Group policies. Works with Underwriting department and ensure all benefits and treatments accepted by the client is set up accordingly in the system. Coordinates with the Business Development Managers, Brokers or Direct Clients and ensure all documentations are collected and processed for internal control and audit purposes. Submit product details to Health Authority of Abu Dhabi (HAAD) to confirm benefit package provided to the client is in line with State Law. Directly coordinates with HAAD representative to resolve issues and discusses the same with Underwriting if needed. Prepares policy agreement as proof of partnership of the insured and Insurer. Ensures proper transition to Client-Servicing team to publish member data and deliver cards to the group within the agreed turn-around time. Technical Support is also responsible in resolving issues arising from Medical Authorization or Claims due to system inconsistency from the setup perspective or technical misalignment. Role is critical to organization requiring eye for quality and analytical thinking.
Client-Servicing Life & Medical Insurance (Mar 2012 - May 2012)
Daily interaction with HR/Insurance coordinators and brokers on providing support as requested. Maintenance of accounts such as additions, terminations and amendments on insured members on group policies in line with customer documents, policy agreement, operational processes and laws implemented in the state. Also prepares and processes for Renewal and New Account Set up member data and card processing. Client servicing also includes invoicing and reconciliation as needed due to customer complaints or internal technical issues.
Works directly with the Head of HR Global SSC, Managers and Leads of HR GSSC, HR Regional SSC Managers, HR Change Manager, HR Project Managers and Head of HR Global Operations.
HR Global Shared Service Center Support - Establishes internal controls in the Global Center to comply with set standards, policies and ways of working. Main goal is to ensure that operations meets and exceeds internal customers’ expectations. This is enabled through monthly monitor of Key Performance Indicators; Creation, maintenance and review of Quality Management; Conduction of Data Protection and Information Security Audits; Alignment and review of Process for Continuous Improvement.
HR Regional Shared Service Centers Support - serves as point of contact for the Regional Shared Service Centers in alignment of services and ways of working. Main goal is to have a standardized approach, process and services. Stands as point of reference for the different Regional Shared Service Centers to come up with one output and input needed by other units in the organization. This involves, delivery framework, service lists, metrics, pricing and other areas. Work and proposals are delivered through facilitation of teleconferences and face-to-face meetings.
HR Global Operations Support - serves within the areas of Project Management and Change Management is provided in Manila as needed. Main goal is to strengthen Project Management skills in the Global Center in preparation for the migration of work to Manila in alignment with HR Transformation. Communication matrix is handled by Manila being the Global Center that holds the different locations together next to HR Global Operations.
Business Analyst (Retirement-Health Care Industry - Business Process Outsourcing)
Billing and Enrollment Business Analysis - Review daily Claim reports to confirm validity of report data. Research data issues and open problem tickets as necessary. Determine root cause of data anomalies in reports. Determine customer (member, provider) impacts and recommend next steps to resolve (e.g. call center outreach, generation of correspondence letter, etc.). Coordinate and implement changes in procedures.
Production Issue Research, Tracking, and Resolution- Serve as point of contact for Billing and Enrollment Managers and other relevant stakeholders for issue resolution. Communicate priorities and status of research items. Determine resolutions for escalated issues. Development of root cause document when necessary. Open demand management tickets as necessary. Work with the application support and test team in getting the status of the fixes and enhancements reviewed and updated regularly.
Support Design and Testing for System Issues or Enhancements- Define business requirements for production fixes or new enhancements. Conduct review sessions of the requirements with the client and the Accenture managers. Review testing scenarios to ensure full and comprehensive test of system changes. Create Test Action Plans for the production fixes or enhancements identified and review with the team.
Account & Process Management - Manages a team of 10-15 analysts with book of business. Leads in client relations, account reconciliation and issue resolution, thus, first point of escalation for procedural and technical issues. Identifies and implements quality improvement methods for the continuous growth of the project. Main responsibility is to drive the team to meet productivity performance objective.
People Management - Performs coaching to supervisors and staff members for strengths and areas of improvement. Quality coaching based on historical and current scores for real time feedback and performance check of the analysts. Provide formal performance appraisals to members of the team. Manage risks and issues related to operations and other adhoc tasks as a supervisor.
Responsible for reconciling payment received with the invoice issued by the company to the customer through supporting documents of the payment. Issue discrepancy reports to show balance due from the customer. Liaise with the Revenue Account Specialist counterparts for any reconciliation issues or pending information required to complete payment processing.
2001 - 2005 DE LA SALLE UNIVERSITY - MANILA Bachelor of Science degree in Commerce, major in Management of Financial Institutions, June 2005
1997 - 2001 ST. SCHOLASTICA'S COLLEGE - MANILA High School Diploma, March 2001 Graduated with Academic Distinction; Loyalty Award; Academic merits 2nd yr, 3rd yr, and 4th yr HS