John Harren Malicse
Lot 10 Orchids St, South Signal Village Taguig, Metro Manila,00
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
5
5
years of professional experience
Work History
Claim Specialist
Hinduja Global Solutions
Twenty-Four Seven McKinley24 7th Ave, Taguig
02.2023 - Current
- Adhere to the policies and procedures established for the client or team.
- Knowledge of timely filing deadlines for each designated payer.
- Takes initiative to analyze, identify and resolve issues causing payer payment delays.
- Take initiative to analyze, identify and trend claims issues to proactively reduce denials communicates to management any issues and/or trends identified.
- Initiate appeals when necessary.
- Ability to identify and correct medical billing errors.
- Send appropriate appeals, including accurate requested information, supporting documentation, and effective communication to complete recovery process.
- Understanding of under or over payments and credit balance processes. Works special A/R project as needed.
- Mentoring the other team members when needed.
- Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act ( HIPAA) standards
- Work Independently form assigned work queues.
Customer Service Representative
Carelon Global Solutions
Address: Alliance Global Tower 24th - 29th Floors,
09.2019 - 10.2022
- Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
- Expedited claim approvals by promptly submitting necessary documentation to insurance providers.
- Served as a subject matter expert for peers and supervisory staff, providing guidance on best practices in benefit verification processes.
- Conducted regular audits of completed work to maintain quality control standards within the department continuously improving overall performance levels.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
Education
Bachelor of Arts - Safety And Security Management
Philippine State College of Aeronautics
Piccio Garden, Pasay, 1630 Metro Manila05.2019
Skills
- Claims Investigation
- Claims analysis
- Customer Service
- Teamwork and Collaboration
- Active Listening
- Medical Terminology
- Proficient in [Microsoft Excell, PDF and Google Sheet]
- Excellent administrative abilities
Achievements
- Promoted as Claim Specialist II
- Certified as Subject Matter Expert
Timeline
Claim Specialist
Hinduja Global Solutions
02.2023 - Current
Customer Service Representative
Carelon Global Solutions
09.2019 - 10.2022
Bachelor of Arts - Safety And Security Management
Philippine State College of Aeronautics