Healthcare
Metro Manila
I am a graduate of Bachelor of Science in Medical Technology, which gave me a strong foundation in healthcare and medical terminology. For the past five years, I have been working as a Claims Specialist at Optum, where I review and process healthcare claims while ensuring accuracy, compliance, and timely resolution. Through this role, I have developed strong analytical, problem-solving, and customer service skills, as well as the ability to work efficiently in a fast-paced environment. I'm now looking for an opportunity where I can continue to grow professionally, apply my healthcare knowledge, and contribute to a team that values quality and excellent service
Optum, full_time
Mar 2018 to Dec 2024
Assisted members with healthcare benefits, eligibility, claims, and coverage inquiries through phone, chat, and web support. Reviewed, investigated, and processed medical claims while ensuring compliance with company policies and client guidelines. Resolved claim discrepancies by analyzing medical documentation, billing information, and insurance policies. Provided accurate information regarding claim status, reimbursements, deductibles, copayments, and prior authorizations. Handled website and portal-related concerns, including account access, navigation, and technical troubleshooting. Coordinated with healthcare providers, insurance carriers, and internal departments to resolve complex member issues. Maintained confidentiality of protected health information (PHI) in accordance with HIPAA and company policies. Documented customer interactions and claim resolutions accurately using internal systems. Achieved productivity and quality targets while delivering excellent customer service in a fast-paced environment. Demonstrated strong problem-solving, analytical, and communication skills to ensure timely issue resolution.