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Richard Aleta, Policy Administrative Coordinator

Richard Aleta

Policy Administrative Coordinator·Arabian Shield Cooperative Insurance Company

Saudi Arabia

Bachelor's degree, Math

Work experience

Total years of experience: 19 years, 7 months

Policy Administrative Coordinator

September 2012 - Present

Arabian Shield Cooperative Insurance Company

Riyadh, Saudi Arabia

September 2012 - Present

'Provide a full range underwriting support and customer service.
' Develops and maintains business unit relationship.
' Process and provides medical insurance card to clients in line with the policy terms & company procedures.
' Responsible for receiving correspondence & medical documents such as reimbursement claims and other documents that supports client requests.
' Responsible to make follow up and coordinate in main office with regards to all the concerns of clients and members. (Reimbursement claims, approval status etc. etc.)
Company industry:
Insurance & TPA
Job role:
Administration

Policy Administrative Coordinator

September 2012 - October 2013

Almarai Co

Saudi Arabia

September 2012 - October 2013

Policy Administrative Coordinator (Almarai Co.) (Sept. 25, 2012 up to present)

Responsibilities:
• Provide a full range underwriting support and customer service.
• Develops and maintains business unit relationship.
• Process and provides medical insurance card to clients in line with the policy terms & company procedures.
• Responsible for receiving correspondence & medical documents such as reimbursement
claims and other documents that supports client requests.
• Responsible to make follow up and coordinate in main office with regards to all the concerns of clients and members. (Reimbursement claims, approval status etc. etc.)
Company industry:
FMCG
Job role:
Management

Medical Claims Processor / Claims Processing Supervisor / Medical Claims Accounts

August 2009 - October 2013

Arabian Shield Cooperative Insurance Company

Saudi Arabia

August 2009 - October 2013

Medical Claims Processor / Claims Processing Supervisor / Medical Claims Accounts
Supervisor / Admin Policy Coordinator (Almarai Company)
Arabian Shield Cooperative Insurance Company
August 13, 2009 up to present
Company industry:
Insurance & TPA
Job role:
Accounting and Auditing

Medical Claims Account Supervisor

February 2012 - September 2012

February 2012 - September 2012

Medical Claims Account Supervisor (Feb. 29 to, 2012 to Sept. 24, 2012)

Responsibilities:
• Responsible is assuring the accuracy of accounts being transferred to the provider.
• Monitor and follow up claims not paid in timely manner.
• Responsible for overseeing the daily cheque and to monitor the accuracy of daily
payment to the provider.
Job role:
Accounting and Auditing

Claims Processing Supervisor

June 2011 - February 2012

Monitor

June 2011 - February 2012

Claims Processing Supervisor (June 29, 2011 to Feb. 28, 2012)

Responsibilities:
• Examines, evaluates, and audit claims for medical, dental, and behavioral health
program.
• Handles complex claims, troubleshooting inaccuracies, performing audits, and researching adverse benefits determination pursuant to federal legislation and
regulation; recommending action on appeals; negotiating letters of agreement and single case agreement with out of network providers and data analysis of aggregated
claims data.
• Responsible for maintaining, upgrading and configuring the automated claims processing
system.
• Review, record & elevate outstanding claims to our Manager.
Company industry:
Public Administration
Job role:
Medical, Healthcare, and Nursing

Medical Claims Processor

August 2009 - June 2011

Medical Dept

August 2009 - June 2011

Medical Claims Processor (August 13, 2009 to June 28, 2011)

Responsibilities:
• Familiarize himself with all company's procedures and operations.
• Performs all duties assigned within the Medical Dept.
• Develops knowledge and experience in the insurance related matters, in general & in
Medical Insurance in particular.
• Responsible for receiving correspondence & medical documents.
• Review, record & elevate outstanding claims to supervisor.
• Process valid claims for settlement in line with policy terms & company procedures.
Company industry:
Other Healthcare Services
Job role:
Medical, Healthcare, and Nursing

Claims Assistant

October 2007 - April 2008

Globe Med Saudi

Saudi Arabia

October 2007 - April 2008

Claims Assistant
Globe Med Saudi
October 28, 2007 to April 10, 2008
Responsibilities:
• To enter data into computer database and organize and maintains files.
• To scan claims and forward into the Claims Processor for processing.
Company industry:
Insurance & TPA
Job role:
Customer Service and Call Center

Digital Subscriber Line Installer

July 2006 - July 2007

Philippine Long Distance Telephone Company (PLDT) - (PC

July 2006 - July 2007

Digital Subscriber Line Installer
Philippine Long Distance Telephone Company (PLDT) - (PC TECH Contractor)
Ramon Cojuangco Building, Makati Avenue, Makati City, Philippines
July 03, 2006 to July 16, 2007
Job role:
Information Technology

Technical Assistant

February 2006 - July 2006

Bell Management Consultancy

Philippines

February 2006 - July 2006

Technical Assistant
Bell Management Consultancy
Feb. 13, 2006 to July 30, 2006
Metro Manila, Philippines
Job role:
Engineering

Fragrance Consultant

June 2005 - February 2006

Rustan Marketing Corporation

June 2005 - February 2006

Fragrance Consultant
Rustan Marketing Corporation
Makati City, Philippines
June 28, 2005 to Feb. 6, 2006
Company industry:
Sales Outsourcing
Job role:
Sales

Education

Far Eastern University

January 2005

January 2005

Bachelor's degree, Math

Far Eastern University Bachelor of Science in Math Major in Computer Science 2001 - 2005 Granary Co - Educational Institution Secondary Level

Skills

Claims Administration
Expert
Claims Administration
Expert
Insurance
Expert
Insurance
Expert
Computer Hardware Troubleshooting
Expert
Computer Hardware Troubleshooting
Expert
Coordination
Expert
Coordination
Expert
Team Leadership
Expert
Team Leadership
Expert
CLAIMS
CLAIMS
CLAIMS PROCESSING
CLAIMS PROCESSING
CLIENTS
Intermediate
CLIENTS
Intermediate
CORRESPONDENCE
Expert
CORRESPONDENCE
Expert
CUSTOMER SERVICE
Intermediate
CUSTOMER SERVICE
Intermediate
LOANS
Intermediate
LOANS
Intermediate
MEDICAL CLAIMS
MEDICAL CLAIMS
MEDICAL INSURANCE
Expert
MEDICAL INSURANCE
Expert
OPERATIONS
Intermediate
OPERATIONS
Intermediate
PROCESSOR
PROCESSOR
Claims Administration
Expert
Claims Administration
Expert
Insurance
Expert
Insurance
Expert
Computer Hardware Troubleshooting
Expert
Computer Hardware Troubleshooting
Expert
Coordination
Expert
Coordination
Expert
Team Leadership
Expert
Team Leadership
Expert

Languages

Arabic
Beginner
English
Expert
Tagalog
Expert