LUNES, JOSE LLOYD F.
182 National Road
Muzon, Taytay, Rizal
Contact No-/--
QUALIFICATIONS
Computer literate (MS Windows, Word & Excel)
With good communication and interpersonal skills
WORK EXPERIENCES
Feb 6, 2006 – Present
Accenture Inc.
Accenture Inc. Work History:
July 1, 2009 – Present
Project Neptune - Atlantis
Senior Claims Analyst/Adjuster
Job Description:
Adjusting the claims that are:
o processed in error (paid or denied in error/incorrect benefits applied)
o affected by new updates caused by policy changes
o previously denied but with special admin. or manager's approval to pay the
claim
o pended due to medical review
Leads the auditing piece for the SAT (Simple Adjustment Tracking) Training for
Chennai
Coordinates on the results and provides action items on the areas of opportunities of
the SAT folks from Chennai
Feb 6, 2006 – June 30, 2009
Claims Analyst
(FTE status – Feb 6, 2006 – Apr 16, 2007)
Job Description:
Primary role is to review completeness and accuracy of insurance claims to ensure
that healthcare policy guidelines are followed prior to authorizing payment or filing a
request for a medical review.
Responsible for accurate and timely processing of health claims. This may include
additional investigation to obtain necessary information to complete the claim
Responsible for the completion of straightforward and stand-alone tasks with
possibly high-volume transactions following predefined procedures.
Verify the validity of medical claims submitted by doctor's offices, hospitals and
patients
Determine whether insurance companies will make payments to doctors, members
and/or hospitals
Determine whether to accept or deny coverage for patients based on policy
guidelines, diagnoses and services
Apply the correct benefits and payment on the claims
TRAININGS ATTENDED (On the Job Training)
Nov 30, 2004 – Jan 21,- hrs.
Sta. Lucia East Commercial Corp.
Clerk – Leasing Dept. / OJT
Nov. 10, 2003 – Dec 27,- hrs.
Anonymous Shop
Sales Clerk / OJT
EDUCATIONAL BACKGROUND
Tertiary
Polytechnic University of the Philippines
Bachelor of Science in Business Administration Major in Marketing
2005
Secondary
Taytay National High School
2001
Primary
Muzon Elementary School
1997
PERSONAL DATA
Age
Date of Birth
Sex
Civil Status
Height
Weight
Religion
Nationality
33
May 18, 1984
Male
Married
5’ 6” ft
130 Lbs
Roman Catholic
Filipino
