Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Timeline
Generic

RICARDO JR AY-YAD

Health And Benefits - Project Manager
Paranaque City

Summary

Health & Benefits professional with 13+ years of experience in U.S. healthcare systems, pharmacy benefit management (PBM), fraud analysis, and data reporting. Currently managing PBM contracts and vendor performance as a Project Manager at WTW. Adept in RFP execution, benefit plan compliance (SPD, SOW), financial modeling, and client presentations. Strong collaborator with proven success in leveraging data to drive plan savings, compliance, and performance improvements.

Overview

14
14
years of professional experience
3
3
Certifications

Work History

Health & Benefit Project Manager

Willis Towers Watson
TAGUIG
04.2023 - Current
  • Serve as a strategic partner to pharmacy consultants by managing Client–PBM relationships and resolving issues related to contracts, scopes of work (SOWs), and performance guarantees with major PBMs such as CVS Caremark, Express Scripts, OptumRx and CapitalRx.
  • Led critical audit support and identified a contractual oversight that resulted in significant client recovery.
  • Discovered rebate reporting discrepancies, recovering over $15K for clients.
  • Uncovered inaccuracies in the Benefit Plan Summary, preventing compliance issues.
  • Audit and validate quarterly rebate reports to ensure contractual compliance.
  • Support multi-year value proposition analyses for savings opportunities.
  • Successfully managed multiple projects simultaneously by prioritizing tasks according to urgency, resource availability, and alignment with organizational goals.
  • Coordinated cross-functional teams and resolved conflicts, maintaining a positive work environment throughout the project lifecycle.
  • Improved client relationships, consistently meeting or exceeding project expectations, and maintaining open lines of communication.

Senior Fraud Specialist

Optum Global Advantage
TAGUIG
04.2021 - 03.2023
  • Led investigations into provider claims, including historical submissions, pre-payment denials, and post-payment verifications.
  • Managed 20+ fraud cases in a day to achieved daily target with high accuracy
  • Ensured adherence to SLAs and improved claims outcomes.
  • Reviewed and resolved complex claims across commercial, government, and health plan sectors, as well as Medicare and Medicaid.
  • Conducted trend analysis to uncover fraud patterns and support risk mitigation.
  • Maintained compliance with state and federal regulations.

Sr. Data Management Analyst

IQVIA Solutions Operations Center Philippines, Inc.
TAGUIG
06.2016 - 04.2021
  • Selected for a leadership development program, led the process improvement in reducing idle time for 50%, increase FTE utilization and cross function trainings and reducing training costs.
  • Verified and validated pharmaceutical, hospital, and healthcare product data for the German market.
  • Maintained data integrity through regular validation processes.
  • Generated tailored client reports per contractual agreements.
  • Trained staff and supported cross-functional reporting tasks.

Medical Claims Specialist

Accenture Inc.
Quezon City
10.2011 - 05.2016
  • Processed and analyzed U.S. healthcare claims, ensuring accuracy and compliance.
  • Pioneered the Member-Submitted Claims team, automating processes to boost productivity by 15%.
  • Identified and resolved claim discrepancies, including fraudulent entries.
  • Served as SME, mentoring staff and driving best practices.
  • Cross-trained across multiple operational roles.
  • Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
  • Maintained accurate patient records by diligently updating databases and following strict documentation guidelines.
  • Improved claim processing efficiency by streamlining workflows and implementing best practices.

Education

Bachelor of Science - Marketing Management

Polytechnic University of The Philippines - Manila
Manila
04.2001 -

Skills

  • Technical and Analytical Skills:

  • Claims Adjudication & Reconciliation

  • Contract Review & Performance Guarantee Tracking

  • Audit Coordination & Compliance Reporting

  • Project & Process Management:

  • Process Improvement & Workflow Optimization

  • Stakeholder Communication & Engagement

  • Project Planning & Execution

  • Task & Project Tracking (Jira, Trello)

  • Work flow planning

  • Client relations

  • Document management

Accomplishments

  • Phoenix Awardee (WTW) – For achieving client, consultant, and leadership commendations.
  • Mt. Everest Award (IQVIA) – Highest award given to employees with multiple distinctions including MVP and process improvement impact.

Certification

Communicating In Groups and Teams

Timeline

Communicating In Groups and Teams

06-2025

Better Business Writing in English

06-2025

Project Management Fundamentals

06-2025

Health & Benefit Project Manager

Willis Towers Watson
04.2023 - Current

Senior Fraud Specialist

Optum Global Advantage
04.2021 - 03.2023

Sr. Data Management Analyst

IQVIA Solutions Operations Center Philippines, Inc.
06.2016 - 04.2021

Medical Claims Specialist

Accenture Inc.
10.2011 - 05.2016

Bachelor of Science - Marketing Management

Polytechnic University of The Philippines - Manila
04.2001 -

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RICARDO JR AY-YADHealth And Benefits - Project Manager