Abigail Go Esguerra

• BOLT vertical, MPO appeals nurse consultant.
• Reviewed complaints and appeals for Aetna.
• Reviewed medical records and summarized care.
• Maintained 92% to 100% quality score in all handled cases.
• Denied and overturned appeals.
• Coordinated with medical directors and provider resolution team when needed.
• Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
• Demonstrated respect, friendliness and willingness to help wherever needed.
• Skilled at working independently and collaboratively in a team environment.

• Reviewed and passed the NCLEX exam.
• Functioned as wave president.
• Provided daily motivation and coaching as need to fellow scholars.
• Coordinated with assistant managers and lead assistant managers regarding disputes and employee concerns.
• Facilitated reviews for the NCLEX exam.
• Delegated task to team members to meet group requirements.

• Worker's compensation account.
• Trainee

• Vertical: Matrix
• Worker's compensation account.
• Functioned as POC.
• Supervised teams and enforced daily tasks.
• Maintained strict adherence to industry regulations, ensuring compliance with legal and security requirements.
• Manipulated and converted documents to meet needs of individual personnel or projects.
• Prepared documents for projects in accordance with project manager, team, or client specifications.

• Studied inpatient coding.
• Reviewed for CIC certification.

• MSK-Orthonet account. Pioneer account.
• Reviewed prior authorization requests for United Healthcare.
• Prepared cases for USRN team.
• Denied and allowed prior authorization requests.
• Faxed and called providers as needed.

• Case manager for RWJBarnabas Health.
• Reviewed patient charts and plan discharge care.
• Provided follow-up care to patients through house calls.
• Facilitated scheduling for office visits.
• Coordinated with other members of the health team such as pharmacist, social workers, nurses and providers.
• Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Educated patients and families on diagnosis, neurological conditions and processes, treatments and expected outcomes.

• Vertical: Provider Traditional
• Benefits and Claims specialist.
• Dedicated accounts: Aetna Employees / CVS and Aetna Global Benefits
• Functioned as POC.
• Provided support and assistance to AEE/CVS and AGB teams respectively.
• Functioned as SME for AEE/CVS and AGB.
• Daily average score: PCS - 7 to 15; NPS - 5 to 10
• Resolved complaints and escalations.
• Coordinated with different departments such as Pre-cert, COB, Claims processing, Members.
• Exhibited high energy and professionalism when dealing with clients and staff.

• Areas of rotation: OPD, ER, Pedia, Medical, Surgical, OB, NICU, OR/DR
• Improved patient satisfaction scores by providing empathetic, compassionate care to diverse populations.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.
• Educated patients on self-care management, empowering them to take an active role in their overall health and wellbeing.
• Evaluated the effectiveness of care plans regularly, making adjustments as needed based on individual patient needs and progress toward goals.
• Managed patients recovering from medical or surgical procedures.
• Evaluated patient histories, complaints, and current symptoms.

• Area: Dialysis unit, Medical-Surgical ward.
• Provided optimum patient care through individualized nursing care plans.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.
• Recorded details regarding therapies to keep patient charts updated.
• Assessed physical, psychological, physiologic, and cognitive status of patients.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.

• Ranked in Top 9% of class
• Extracurricular Activities: Served as Managing Editor, Editor-in-Chief, and News Editor of the Cadocian, Official Newsletter Calamba Doctor's College, from 2005 to 2009.

NC II Certified.

Undergraduate

• Honor Roll: Fourth Honorable Mention
• Awarded Writer of the Year
• Elected Class President
• Elected Editor-in-Chief