JAN ROSE BANAGUA
Siaton, Negros Oriental
Summary
As appeals professional, brings valuable experience in handling intricate appeal cases and ensuring adherence to industry regulations. Focused on team collaboration and achieving results, known for reliability and adaptability in dynamic environments. Possesses strong analytical skills and excellent communication abilities, highly valued by employers.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Appeals Representative
Optum, Inc
02.2021 - Current
- Expedited the appeals process for faster resolutions by streamlining procedures and workflows.
- Review denied appeals and claims and patients' medical files.
- Created pre-service appeals through accurate identification of service and CPT Code.
- Achieved higher success rates on appeal cases by closely analyzing denial reasons and crafting persuasive arguments for reconsideration.
- Assessed pre-service and post-service appeals to facilitate accurate and timely resolutions.
- Assisted in processing clinical reject cases for nurse evaluation.
Sales Representative and Customer Service
Teleperformance
05.2019 - 02.2021
- Increased revenue by building strong relationships with customers and identifying their unique needs.
- Delivered product knowledge presentations to educate clients and drive informed purchasing decisions.
- Drove sales growth by consistently meeting and exceeding assigned quotas.
- Improved customer retention with timely follow-ups and personalized service.
New Account Specialist
Banco Dipolog Inc.
08.2017 - 05.2018
- Answering questions, explaining services, and referring customers to the appropriate bank personnel.
- Compiling information about new accounts, entering it into computers, and filing related documents.
- Collecting and recording customer deposits and fees, and issuing receipts.
Customer Service Representative
SPI
12.2016 - 06.2017
- Seasonal Account
Technical Support Representative
Qualfon
10.2012 - 03.2015
- Provided remote assistance to customers experiencing technical difficulties, guiding them through step-by-step resolutions with patience and professionalism.
- Improved customer satisfaction by providing timely and accurate technical support for various software and hardware issues.
- Resolved complex technical problems through effective troubleshooting techniques, enhancing the user experience.
- Maintained a high level of expertise on company products, ensuring accurate information was provided to customers at all times.
- Documented customer interactions in detail within the case management system, ensuring comprehensive records were maintained for future reference.
- Delivered exceptional customer service by quickly addressing concerns and providing clear, concise explanations of technical solutions.
- Boosted first-call resolution rates with efficient problem-solving skills and deep product knowledge.
- Managed challenging customer situations with diplomacy and professionalism, often turning negative experiences into positive outcomes.
Education
Bachelor of Science - Business Administration, Financial Management
Negros Oriental Sate University
01.2011
Secondary Education -
Siaton National High School
01.2005
Intermediate Education -
Sandulot Elementary School
01.2001
Skills
- Microsoft office
- Policy interpretation
- Teamwork and collaboration
- Multitasking skills
- Time management
- Attention to detail
- Problem-solving abilities
- Listening skills
- Dispute resolution
- Critical thinking
- Adaptability and flexibility
- Task prioritization
Workshopseminars
- Banco Dipolog Inc. New Accounts Refresher workshop and seminar, Banco Dipolog Inc.
- General & Technical On-Boarding Training
- Refresher workshop and Seminar for Customer Service
Certification
HIPAA Certificate
Timeline
Appeals Representative
Optum, Inc
02.2021 - Current
Sales Representative and Customer Service
Teleperformance
05.2019 - 02.2021
New Account Specialist
Banco Dipolog Inc.
08.2017 - 05.2018
Customer Service Representative
SPI
12.2016 - 06.2017
Technical Support Representative
Qualfon
10.2012 - 03.2015
Secondary Education -
Siaton National High School
Intermediate Education -
Sandulot Elementary School
Bachelor of Science - Business Administration, Financial Management
Negros Oriental Sate University
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