Jane Apple Arellano

Jane Apple D. Arellano Al Barsha South 1, Dubai, UAE -- Job Objective: To be employed in a well established institution which can provide variety of job responsibilities to widen my knowledge and broaden my horizon. Do the best job possible at all times and contribute to the overall success of the company in a number of ways. Professional Profile   Goal-directed, results oriented professional with Bachelor’s degree. Accomplished Technical Specialist with 12 years of experience in the Health insurance and Claims Management Industry, specializing in Customer Service, Technical Troubleshooting, OP-Pre-approvals, Complaints Management & Claims processing. Proven track record of problem-solving in a fast-paced environments and delivering results through collaboration, pro-active communication and process involvement initiatives. Professional Experience Allianz Partners- Dubai United Arab of Emirates 2012 to 2024 Helpline Customer Operations Technical Specialist: 2023 to 2024 -Helpline Technical Specialist|                   Medical Out-patient Pre-approval & Customer Care Quality Audit| Data Analyst | Senior Case Management Providing technical support to customers and internal staff through calls, tickets and emails Troubleshooting and resolving technical issues related to Allianz products and services. Thorough and accurate reporting, logging of all tickets related IT incidents in real time. Collaborating and escalating cross functionally complex technical challenges for resolution. Supporting and handling escalated customer support concerns effectively. Forecasting Call volumes and staffing requirements based on historical data, trends and business need. Monitoring real-time adherence to schedules and make necessary adjustments to optimize productivity. Analyze Helpline Calls data and provide insights to identify opportunities for improving operational efficiency and performance. Collaborating with Helpline Operation Team Leads and Managers to identify and address staffing gaps and operational challenges. Reporting Daily Stats, Monthly, Quarterly of Overall Voice Metrics, e-mails SLA, pre-approvals SLA, IT issues Complaints report, Forecasting, NPS, & Daily PCS results. Reporting Monthly Helpline Global review-Overall KPI and highlights, Monthly Helpline Audit Summary, Operational Risk Event/Loss Reporting and Complaints Analysis report. Conducting and reporting Helpline Internal Audit for Calls, Emails, and Out-Patient Pre-authorization Taking part and support in Complaint Handling management, carry out case management of complex cases. Calls recording review and analysis. Monitoring and reporting customer experience metrics such as customer satisfaction and NPS, ensuring to deliver service that meets departmental customer service standards and targets across calls and emails Acting as Subject Matter Specialist in Helpline with fellow technical specialist. Participates in coaching/ training new/junior members of the team. Participate in the enhancement of workflows and procedures. Other Ad hoc duties as operationally required. Senior Helpline Officer: 2012 to 2023- Customer Care | Medical Out-Patient Officer| Claims Handling| Complaint Executive | Senior Case Management           Medical Out-patient pre-approval –pharmacy and other OP services with compliance to established Policy Guidelines as well as managing & providing overall guidance about Medical Cases review & authorization over Phone. Develop extensive and sound product knowledge in order to provide timely and accurate information to our clients. Calls and emails administrations. Responding to queries regarding cover, pre-approvals, hospitalizations and complaints escalations. Multi-tasking of daily assigned workload as well as ad hoc assignments and follow up on individual cases Proactive in handling client complaints and ensuring customer satisfaction. Has developed understanding of the technical element of claims processing and administration procedures and assisted on claim processing when needed. Coordinating interdepartmental work (Medical services, Claims, Underwriting, Sales & Client relations, Finance, Policy Management & Medical Providers Management Team) to address customer needs or resolve their queries. Assisting TPA’s for review and further information related to claim processing and all related aspects. Provide support in complaints, calls and e-mails reports on daily and monthly basis to the management. Participates in coaching/ training new/junior members of the team. AIG/ Chartis Insurance- Alabang, Muntinlupa City, Philippines, 2011 to 2012 Workers’ Compensation and Property & Casualty Claims Processor:         Conducts investigation to secure essential facts from a wide range of people to ensure understanding of protocols and claims processing. Analyze written reports, such as medical records and legal documentation. Check policies, endorsements, and other policy material for accuracy. Sets up new claim files, secures and determines claim data within established parameters; codes and enters data. Provides a variety of customer service and procedural advice: ensure quality service is achieved and aligned with set guidelines in both inbound and outbound calls as well as emails. Thoroughly documents on-line all actions performed and results achieved or seeks input from other departments to secure appropriate data in a timely manner. Investigate and resolve customer complaints/inquiries/requests in a prompt, effective, and professional manner. Exhibited behavioral competencies relevant to operational goals. Actively participated in company/ division/ unit/ team –wide activities and initiatives. Educational Qualifications & Certifications Bachelor’s Degree in Nursing in 2008- University of Perpetual Help System Laguna,Philippines Certificates: Participated in personal training & development opportunities -Calls Handling and Data ProtectionDepartmental Training 2024 -Performed Connectivity TestingJasmine Project- Allianz Philippines 2023 -Proficiency in Medical Coding Training via 45 hrs of Classroom Training 2019 -Customer Excellence Training 2019 -Employee of the month 2019 -Excellence Award this year 2019 -Introduction of e-Prescription (eRx) Training 2015 -MS Powerpoint 2010 Training Level 2 Course 2014- Sites Power Dubai, UAE -Effective Communication Skills Training 2013 – Al Futtaim Group Learning and Development, Dubai, UAE -AIG/Chartis Team Wow Awards -2012 -AIG/Chartis Rising Tide Award & Silver Compass Award -2011 for outstanding performance and contribution to the Claim Setup Team -English Proficiency for International Communication (EPIC 401) IELTS 2007 -Microsoft Office Specialist -2005 I hereby certify that the above information is true and correct. ___________________ Jane Apple D. Arellano