LAURENCE PASCUA
Sta. Rosa,Philippines
Summary
Experienced Insurance and Eligibility Operations Specialist with over 6 years in benefits verification, policy administration, and quality control. Strong background in insurance portals, payer systems, and CRM platforms, ensuring compliance and accuracy. Focused on prior authorizations, coverage resolution, and efficient documentation in fast-paced healthcare settings.
Overview
1
1
Certificate
10
10
years of professional experience
Work History
Quality Control Specialist
ADEC Innovations
09.2025 - 08.2026
- Conducted QA reviews of eligibility transactions (enrolments, terminations, reinstatements, life event changes) to ensure accuracy and compliance with regulations.
- Led calibration sessions and provided feedback to foster team consistency and ensure adherence to compliance standards.
- Identified discrepancies, documented root causes, and recommended corrective actions to enhance workflow efficiency.
Eligibility Management Processor
ADEC Innovations
09.2024 - 09.2025
- Achieved 98-99% accuracy scores while managing 85+ cases weekly, ensuring high-quality outcomes.
- Ensured compliance with SLAs, fostering client confidence and satisfaction through reliable service.
- Verified insurance benefits and processed enrollments, terminations, and changes, enhancing service delivery for U.S. clients.
Administrative Assistant
JMMS Non-Life Insurance Agency
09.2019 - 09.2024
- Communicated clearly with clients, enhancing service delivery and increasing overall satisfaction.
- Ensured compliance with underwriting requirements while addressing and resolving client concerns effectively.
- Managed policy applications, renewals, and claims for medical and travel insurance, ensuring timely processing and client support.
Sales Assistant
Red Logo Inc.
07.2018 - 07.2019
- Activated 20 memberships in a single day, contributing to increased sales performance.
- Conducted product demonstrations and activated memberships, enhancing customer engagement.
- Assisted customers in selecting products, offering detailed advice to meet their needs.
- Handled customer enquiries, providing prompt responses to questions about products and services.
- Organised shelves to maintain a tidy shopping environment., clean and organised through visual merchandising.
Underwriting Assistant
FPG Insurance
06.2016 - 01.2018
- Supported underwriting for three Toyota branches, contributing to ₱100M in sales.
- Reviewed contracts and processed insurance coverage quotes, policy documentation, and claims submissions to ensure accuracy and compliance.
- Coordinated with brokers and clients to clarify requirements and resolve policy concerns, enhancing communication and understanding of policy details.
Education
Master of Business Administration - strategic management, finance, organizational leadership
Pamantasan ng Cabuyao
01-2025
Bachelor of Science - computer science
Kolehiyo ng Lungsod ng Lipa
01-2016
Skills
- Quality assurance compliance
- Process Improvement
- Data validation reconciliation
- Data entry and reporting
- CRM Systems: Dynamics 365
- CRM & Insurance Portals
- Insurance portals management
- Microsoft Office Suite (Excel, Word, Outlook)
- Patient & Provider Communication
Timeline
Quality Control Specialist
ADEC Innovations
09.2025 - 08.2026
Eligibility Management Processor
ADEC Innovations
09.2024 - 09.2025
Administrative Assistant
JMMS Non-Life Insurance Agency
09.2019 - 09.2024
Sales Assistant
Red Logo Inc.
07.2018 - 07.2019
Underwriting Assistant
FPG Insurance
06.2016 - 01.2018
Master of Business Administration - strategic management, finance, organizational leadership
Pamantasan ng Cabuyao
Bachelor of Science - computer science
Kolehiyo ng Lungsod ng Lipa