Jelvie Ann Paderes
Taytay
Summary
Dynamic individual with hands-on experience in healthcare industry and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
7
7
years of professional experience
Work History
Prior-Authorization Specialist
DME Service Solutions Inc.
11.2024 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
General Insurance Processor
Intogreat Solutions Philippines
03.2023 - 10.2024
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate policy information.
- Collaborated with underwriters for accurate risk assessment, ensuring appropriate coverage recommendations for clients.
- Contributed to a positive work environment by assisting colleagues with heavy caseloads when needed, fostering teamwork across departments.
- Maintained confidentiality of sensitive client information, adhering to company policies and industry regulations on data protection.
General Insurance Processor
TATA Consultancy Services (Philippines)
06.2022 - 03.2023
- Collaborated with underwriters for accurate risk assessment, ensuring appropriate coverage recommendations for clients.
- Achieved high levels of accuracy in data entry tasks through rigorous attention to detail and double-checking inputted information.
- Successfully resolved discrepancies in policy documents through thorough investigation and collaboration with relevant parties.
- Increased accuracy in policy documentation by thoroughly reviewing and verifying data before submission.
- Assisted agents in navigating complex insurance policies, effectively communicating key details and terms to clients.
Insurance Verification Representative
Concentrix Exxa Tower Bridgetown
01.2020 - 05.2022
- Contributed to company growth by consistently meeting performance metrics for speed, accuracy, and client satisfaction in the insurance verification process.
- Reduced claim denials by thoroughly reviewing patient eligibility and coverage details.
- Contributed to office productivity by managing high volumes of inbound calls for insurance verifications.
- Enhanced customer satisfaction with prompt and accurate insurance verifications for medical services.
- Expedited service delivery by promptly addressing questions from patients, providers, and insurers regarding coverage details or policy changes.
Dental Insurance Coordinator
EXL Service Home
05.2019 - 12.2019
- Negotiated pre-authorizations for necessary dental procedures, securing coverage for vital treatments otherwise not covered.
- Supported patients throughout the treatment process by answering questions about their financial responsibility concerning deductibles, copayments, or coinsurance amounts.
- Assisted patients in understanding their dental insurance benefits, coverage limits, and out-of-pocket expenses.
- Educated dental team members on insurance policies and procedures to promote a cohesive office environment focused on quality patient care.
- Reduced billing errors by consistently verifying insurance eligibility prior to service delivery.
- Maintained accurate records of patient treatments, billing information, and insurance details to ensure seamless communication between patients, providers, and insurers.
Technical Support Representative
Teleperformance MAAX
09.2018 - 04.2019
- 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.
Education
Bachelor of Science - Hotel and Restaurant Management
Polytechnic College of Davao del Sur, Inc.
Digos City, Davao Del Sur01.2017
Bachelor of Science - International Travel and Tourism Management
Lyceum of the Philippines University- Cavite
General Trias, Cavite01.2015
Bachelor of Science - Engineering major in Computer Technology
De La Salle University - Dasmariñas
Dasmariñas, Cavite01.2014
Secondary -
Fiat Lux Academe
01.2011
Elementary -
Fiat Lux Academe
01.2006
Skills
- Strong Verbal and Written Skills
- Customer Interaction Proficiency
- Deadline-Driven Task Management
- Technical Proficiency
- Medical terminology
- Insurance verification
- Documentation and paperwork
- Schedule management
- Teamwork and collaboration
- Time management
- Problem-solving abilities
Academic Excellence
First Year Hotel and Restaurant Management 3rd Honor, Polytechnic College of Davao del Sur, Inc., Mc Arthur Highway, Kiagot, Digos City, Davao Del Sur, A.Y. 2016-2017
Personal Information
- Age: 30
- Height: 5' Ft.
- Weight: 60 Kg.
- Father's Name: Antonio B. Paderes
- Mother's Name: Elvie C. Aclao
- Date of Birth: 07/27/94
- Gender: Female
- Nationality: Filipino
- Marital Status: Single
- Religion: Catholic
Languages
English
Timeline
Prior-Authorization Specialist
DME Service Solutions Inc.
11.2024 - Current
General Insurance Processor
Intogreat Solutions Philippines
03.2023 - 10.2024
General Insurance Processor
TATA Consultancy Services (Philippines)
06.2022 - 03.2023
Insurance Verification Representative
Concentrix Exxa Tower Bridgetown
01.2020 - 05.2022
Dental Insurance Coordinator
EXL Service Home
05.2019 - 12.2019
Technical Support Representative
Teleperformance MAAX
09.2018 - 04.2019
Bachelor of Science - International Travel and Tourism Management
Lyceum of the Philippines University- Cavite
Bachelor of Science - Engineering major in Computer Technology
De La Salle University - Dasmariñas
Secondary -
Fiat Lux Academe
Elementary -
Fiat Lux Academe
Bachelor of Science - Hotel and Restaurant Management
Polytechnic College of Davao del Sur, Inc.
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