Detail-oriented healthcare customer service professional with 3 years of experience in handling claims inquiries, dispute resolution, and insurance coverage issues. Seeking to leverage expertise in claims management, bills and payments, and exceptional communication skills with Empathy that contribute to effective recovery efforts.
Professional Experience
Customer Service Representative (Healthcare Insurance)
Optum Global Advantage – Alabang, Muntinlupa, City
October 2021 – Present
Provide support to policyholders by resolving inquiries related to healthcare claims, coverage, and billing discrepancies.
Investigate claim disputes and coordinate with internal teams to ensure accurate processing and payment of claims.
Educate customers about their health insurance benefits and subrogation process when a third-party is liable.
Identify claims with potential subrogation opportunities, referring cases to the subrogation team for further investigation.
Maintain a 100 % resolution rate, ensuring quick and efficient service while adhering to compliance and privacy standards.
Handled escalated customer inquiries regarding denied claims, appeals, and subrogation matters.
Supported the recovery process by identifying claims where third-party liability was possible, referring those cases for further investigation.
Telemarketer
Morphlings Solution
Banaybanay Cabuyao,Laguna
February 2020-January 2021
Promoting car insurance products, generating leads, and providing exceptional customer service. Seeking to contribute my communication skills, product knowledge, and sales abilities to a dynamic insurance sales team.
Education
Bachelor of Science in Business Administration
Cebu Institute Technology University-Cebu city
Graduation: June 2023
Skills
Claims, Billings and Payment processing and healthcare insurance expertise
Customer service and problem resolution
Knowledge of healthcare compliance and privacy regulations (HIPAA)
Strong communication and negotiation skills
Other Skills:
Social Media Management
