Antonio F. Email & Phone Number

Mexico City, Mexico

Ciudad De México, México

Risk Evaluation: Utilize medical and financial documents, including blood tests, cardiovascular reports, and accounting records, alongside Swiss Re's Life Guide and guidance from Medical Officers, to establish precise risk recommendations.Facultative Life Risk Selection: Deliver accurate and competitive facultative life risk assessments, consistently meeting or surpassing Swiss Re's global time service standards.Standards Compliance: Uphold underwriting standards and processes in accordance with Swiss Re's underwriting principles.Process Knowledge: Develop comprehensive knowledge of the facultative underwriting process, providing support for special programs and business functions as required.Cross-Functional Support: Assist cross-functional teams with underwriting insights for pricing, marketing, research, and claims tasks.Industry Awareness: Stay informed about current and emerging business policies, practices, and trends.Client Engagement: Prepare and provide onsite support for client-facing activities, including training sessions, underwriting support for quotes and pricing assessments, audits, and other ad hoc requests.Tool Translation: Support the translation of Swiss Re's underwriting-related tools.

Mexico City, Mexico

Conducted thorough examinations of medical claims for employees of major international clients in Mexico, including Aspen Pharmacare, Huawei, Lanxess, MSD, Merz Pharma, Mitsui, Lundbeck, Swoboda, WeWork, among others.Analyzed health insurance policies to ensure smooth transitions for clients between insurance companies.Identified claims issues that could impact the indemnization process.Forecasted loss ratios for high-dollar medical claims.Provided direct assessments for insured individuals and treating physicians in complex cases.

Ciudad De México Y Alrededores, México

Managed and analyzed the loss ratio of the personal accident policy “Va Segur@” from the Fideicomiso de Educación Garantizada, covering over 1.9 million public school students in Mexico City.Coordinated medical attention for injured patients through TPA (SEMEDIC).Negotiated costs with private hospitals for ambulatory medical care packages.Conducted personalized claims analysis for VIP accounts at BROVE & AAR brokers.Examined medical claims under the Policía Federal health policy and coordinated their medical attention.

Mexico City Area, Mexico

Claims Management: Design and oversee the management of the Injury Claims process through comprehensive data analysis provided by the Third-Party Administrator (TPA).Process Mapping: Advise on process mapping for Injury Claims to ensure streamlined and efficient operations.Contingency Planning: Develop alternate operational scenarios to address potential contingencies and ensure business continuity.Medical Network Development: Establish and maintain a medical network, setting system reserves for ambulatory and hospitalized patients based on diagnosis.Fee Updating: Update medical procedure fees in accordance with Current Procedural Terminology (CPT) to ensure accurate billing and reimbursement.Personnel Training: Conduct training for personnel involved in the operation, including Call Center staff, Medical Analysts, and Medical Providers, to ensure effective and consistent claims processing.

Mexico City Area, Mexico

Mexico City Area, Mexico

Mexico City Area, Mexico

Bachelor Of Medicine, Bachelor Of Surgery - Mbbs, Medicine

Specialty, Health’S Organizations Administration