FERDINAND LUZARES
Mandaluyong City
Summary
Experienced in claims analysis and processing with strong focus on compliance management and customer service. Skilled in policy interpretation and document review, offering expert time management and problem-solving abilities. Eager to leverage skills as a Life Claims Specialist/Supervisor to enhance claims processing and support team objectives
Overview
22
22
years of professional experience
1
1
Certification
Work History
Claims Specialist/Supervisor
Etiqa Life & General Assurance Corporation
10.2019 - 03.2026
- Analyze Death, Personal Accident & Dismemberment, Accidental Medical Reimbursement, Hospital & Daily Income Benefit, Total Permanent Disability, Group Living Benefit & Critical Illness Benefit claim. Secures Actuarial, Underwriting, Legal and/or Medical input where necessary
- Recommend initial assessment on the claim for Claims committee approval
- Monitor & Process claims within turnaround time
- Handled claim inquiries of varying complexity, ensuring timely and accurate resolutions.
- Coordinates with other departments regarding concerns affecting the claims and also with external clients
- Compiled and delivered weekly, monthly, and year-end internal claims and utilization reports for management review.
- Prepares Business System Requirements for system enhancements & automation process
- Conducts User Acceptance Testing (UAT) for project product initiatives
- Coached and trained team members in the Life Claims Section.
- Support Business Continuity program and also DR testing as scheduled
- Represented the company alongside Legal in mediation sessions and court hearings, addressing appraised cases to support compliance and resolution.
Policy Services Supervisor
Etiqa Life & General Assurance Corporation
06.2016 - 10.2019
- Processes VLI policy amendments, reinstatements, fund switching, fund withdrawal, policy surrenders and other policy related transactions.
- Prepares and sends annual Fund Statement of Account, according to Anniversary Date.
- Entertains/accommodates walk-in clients.
- Attends to inquiries related to policy servicing
- Prepares policy related computations as requested by policyholder, insurance representative and branch personnel.
- Properly maintains policy documents for imaging and filing.
- Performs special projects and other related jobs as may be required from time to time by management.
- Conducts User Acceptance Testing (UAT) for project product initiatives and supports Business Continuity and DR testing as scheduled.
- Prepares BRS (business requirements) for work process improvements automation and design process.
Corporate Solutions Operations Associate (Group) - Processor
BPI-PHILAM Life Assurance Corporation
08.2014 - 06.2016
- Validates policy digest against compass policy setup
- Updated client/policy information in compass, ensuring accuracy within TAT targets
- Updated member details based on policy movement reports from clients, maintaining compliance within TAT targets
- Updates member's medical underwriting rating within the TAT target based on approval from underwriting department.
- Provided members with necessary certificates for their records
- Receives policy digest from renewal team
- Issues member certificates
- Generates and releases bills within TAT target
Underwriter
Paramount Life & General Insurance
01.2014 - 05.2014
- Check for completeness of documents submitted.
- Underwrite all nonmedical and medical cases
- Prepare declined letters to include refund check, if any.
- To match incoming requirement to respective files.
- To re-assess cases with new non-medical requirements provided.
- Notify the agents on status of pending cases
- Facilitate other request by supervisor and manager
New Business Assistant
Generali Philippines
03.2013 - 05.2013
- Answered inquiries from Financial Advisors and clients to provide timely and accurate information.
- Receives and checks underwriting requirements.
- Receives application through fax and checks completeness.
- Receives application through fax and checks completeness.
- Received and verified underwriting requirements to ensure compliance and facilitate processing.
- Supported supervisor and manager by addressing additional requests, improving team collaboration.
- Provided backup support for policy issuance.
Associate Policy Issuance/Reviewer
Sun life of Canada Phils.
07.2008 - 12.2012
- Provided assistance to customers by addressing inquiries and concerns.
- Reviews and evaluates new business requirements
- Analyzes correct premium coverage applied in policy form, proposal and payment in the applications
- Adjusted records in underwriting system to maintain accurate case documentation.
- Computes and collects additional payment/charges based on the amount of per product classification if any discrepancy.
- Computed and collected additional payments or charges for discrepancies in product classification.
- Answers customer inquiries & concern
Technical Staff / Data Center Operator
Sunlife of Canada Phils
09.2003 - 07.2008
- Facilitate daily batch processing of systems
- Operated and maintained computer hardware and equipment in Computer Center according to operating procedures. Monitored status of hardware, equipment, and network daily; logged and reported system problems or downtime.
- Handled regular backup of all systems and facilitated approved restoration requests.
- Conducted testing and managed disaster recovery processes to safeguard critical data and ensure business continuity.
- Submitted daily operational shift logs and reports to track system performance.
- Provided critical support to maintain system functionality during weekends and holidays, ensuring uninterrupted operations.
- Conduct Data Center monthly shutdown of servers/machines and maintenance
Education
Bachelor of Science in Commerce - Major in Computer Science & Information System
Centro Escolar University
Skills
- Claims processing
- Policy Interpretation
- Compliance management
- Document review
- Risk Assessment
- Analysis & investigation
- Performance Metrics
- Decision making
- Customer service
- Teamwork & collaboration
- Interpersonal skills
- Active Listening
Certification
Loma passer
Languages
English
First Language
Timeline
Claims Specialist/Supervisor
Etiqa Life & General Assurance Corporation
10.2019 - 03.2026
Policy Services Supervisor
Etiqa Life & General Assurance Corporation
06.2016 - 10.2019
Corporate Solutions Operations Associate (Group) - Processor
BPI-PHILAM Life Assurance Corporation
08.2014 - 06.2016
Underwriter
Paramount Life & General Insurance
01.2014 - 05.2014
New Business Assistant
Generali Philippines
03.2013 - 05.2013
Associate Policy Issuance/Reviewer
Sun life of Canada Phils.
07.2008 - 12.2012
Technical Staff / Data Center Operator
Sunlife of Canada Phils
09.2003 - 07.2008
Bachelor of Science in Commerce - Major in Computer Science & Information System
Centro Escolar University