Edmar Guieb
Antipolo City,Calabarzon (Region IV-A)
Summary
A dedicated and hard-working person with a bachelor’s degree in Secondary Education and intensive office management knowledge. Attentive to detail, able to multitask, and well-organized while maintaining a high level of professionalism. Proficient in MS Office, Outlook, Email Triage and familiar with Google Applications. I am highly motivated to continue learning and improving my craft and am willing to impart my knowledge to help the company I will be working with.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Administrative Specialist (Virtual Assistant)
Patra Corp (Brightway Insurance)
Pasig City, Philippines
08.2024 - Current
- Generate policy declarations page, invoices, receipts, ID card, and ensure accurate policy-related records are sent through email and fax.
- Process customer payments via credit card and e-check.
- Maintained comprehensive digital filing systems for easy retrieval of documents.
- Handled updating files (policy details, billing schedule and set-up, mortgage changes on the carrier site) and faxing communications with the Mortgage and Insurance Department.
- Sent, received, routed, and distributed incoming calls, emails, and chat.
- Provided customer service via phone, email, and chat, addressing inquiries with policy details, coverage, and resolving issues to maintain high satisfaction levels.
- Secured data by following confidentiality procedures.
Medical Claims Specialist- Account Receivable
Med-Metrix Phils(Nevada Heart and Vascular Center)
Pasig City, Philippines
11.2022 - 05.2024
- Review, verify, and process medical claims submitted by providers, patients, or billing companies.
- Check patient eligibility, coverage limits, authorizations, and benefits.
- Verify coding accuracy (ICD, CPT, HCPCS) and documentation against submitted claims.
- Apply policy provisions, fee schedules, reimbursement rules, and identify discrepancies, errors, or fraudulent claims.
- Ensure adherence to HIPAA, insurance regulations, and company policies.
- Confirm that payments are posted accurately to patient accounts.
- Reconcile payments with Explanation of Benefits (EOBs) or remittance advices.
- Answer inquiries regarding claim status, benefits, or payment details.
- Provide clear explanations of coverage, and claim decisions.
- Receive and process PA requests from providers or members.
- Verify member eligibility, benefits, and coverage requirements.
- Gather the required clinical documentation, medical records, and other information to support PA requests.
- Submit PA requests to insurance carriers or payers for review.
- Track and follow up on pending authorizations to ensure timely decisions.
- Investigate denied or underpaid claims.
- Assist with the resubmission, correction, or appeal of claims when necessary.
- Monitor appeal status and communicate determinations to members, and providers.
- Collect supporting documents (e.g., medical necessity letters, clinical notes).
Pharmacy Helpdesk Specialist
Teletech (OptumRx)
Cainta, Rizal, Philippines
11.2018 - 11.2022
- Answer inbound calls and emails from patients, providers, and pharmacies.
- Assist with prescription status, refills, and medication coverage.
- Verify insurance eligibility, benefits, and coverage for prescriptions.
- Provide information on formulary, copayments, and coverage limitations.
- provide prior authorization support.
- Follow HIPAA and company policies to safeguard patient information.
- Ensure adherence to regulatory and insurance requirements.
Education
Bachelor of Science - in Secondary Education (Major in English)
Institute of Creative Computer Technology (ICCT)
Cainta, Rizal01-2023
Skills
- Customer service
- Policy administration
- Claims processing
- Data entry
- Document management
- Insurance verification
- Payment reconciliation
- Regulatory compliance
- Prior authorization
- Adaptive problem solving
- Confidentiality adherence
- Positive attitude
- Customer service excellence
- Administrative skills
- Creative thinking
- Flexibility in task handling
- Organisational skills
- Time-management
- Decision making
- Active listening
- Effective communication
- Customer engagement
- Record-keeping
- Attention to Detail
- Email handling efficiency
- Document preparation
- Computer literacy
- Multitasking mastery
- Data organisation
- Time efficiency
- Mail and fax handling
- Decision-Making confidence
- Critical-thinking
- Confidentiality awareness
- Task prioritization
- Telephone etiquette
- MS Office Suite
- Typing speed and accuracy
- Email and live chat support
Internship
ICCT COLLEGES
E-Learning Support Staff
January 16, 2023-April 1, 2023
Personal Info
Date of Birth : February 11, 1988
Place of Birth : Quezon City
Civil status : Married
Nationality : Filipino
Additional Skills
- Knowledgeable in using Canva
- Proficient in CRM Systems, Microsoft Office, Outlook, BWIC, Fusion, and Google Applications
- Experienced in Insurance Portals and EHR Tools such as EPIC, Athena Practice, Athena EDI, Med-Streaming, AMS360, GUI, and Mpower
Certification
. General Virtual Asistant
.Virtual Executive Assistant
.Basic WordPress
.Social Media Management
VirtualWork PH
An online course with practical, straight-forward, and easy-to-learn video lessons on how to become a professional Virtual Executive Assistant
December 2024
Timeline
Administrative Specialist (Virtual Assistant)
Patra Corp (Brightway Insurance)
08.2024 - Current
Medical Claims Specialist- Account Receivable
Med-Metrix Phils(Nevada Heart and Vascular Center)
11.2022 - 05.2024
Pharmacy Helpdesk Specialist
Teletech (OptumRx)
11.2018 - 11.2022
Bachelor of Science - in Secondary Education (Major in English)
Institute of Creative Computer Technology (ICCT)