Jeffrey Cayetano Cera Email & Phone Number

Dubai, United Arab Emirates

✓ Review both real-time and retrospective telephony and web-based interactions with member to ensure they are carried our in a compliant, customer-centric manner and in line with FCA Regulations. ✓ Use knowledge and experience to determine whether the customer has received the correct outcome and whether the customer experience fits with the Bupa brand.✓ Develop and extensive knowledge of the current procedures and processes to ensure that all interactions are assessed accordingly.✓ Using the agreed Quality Assurance procedures, participate in reviews of colleagues to ensure consistency of Quality Assurance and decision making✓ Identify interactions containing non-conformances/breaches and provide appropriate feedback to the Customer Relations Management team to be discussed with individuals and addressed through corrective action plans✓ Identify and report any recommendations for improvements in processes and support the delivery of these improvements

Dubai Emirate, United Arab Emirates

✓ Responsible in managing the team of preauthorization specialist, delegating tasks and overseeing the quality of preauthorization process. ✓ Supervising team outputs as well as individual performance. ✓ Escalates issues concerning the department and operations to the manager and implement recommended plan of actions. ✓ Monitors random calls, e-emails, pre-auth requests to improve quality, minimizes errors and track operative performance. ✓ Asses performance of team function and support in developing skillsets to fulfill task requirements. ✓ Monitors and audit daily performance to ensure the best possible costumer service. ✓ Ensuring the requests are preauthorized accurately and efficiently. ✓ To quickly identify discrepancies and able to prevent errors ✓ Support the team in handling complaints and escalations ✓ Reviews the performance of staff, identifies staff training needs and plan training sessions. ✓ Responsible for internal assistance for preapproval ✓ Providing monthly reports and assist in scheduling. ✓ Conduct trainings and skill share related to preapproval ✓ Responsible to give pre-authorization approvals to hospital providers who need any medical services such as: In Patient, Out Patient, Optical, Dental, Pharmacy, for eligible members of a specific insurance company. ✓ Answer calls from physician, offices, hospitals, and patients using exemplary costumer service skills. ✓ Effectively handling and assessed claims medically thru E-PAR, PBM, correlating diagnosis and services as per member’s policy terms and conditions.

United Arab Emirates

✓ To proactively provide medical pre-authorization to hospitals, pharmacies and clinics based on company guidelines and policy terms conditions. ✓ Review structured clinical data matching it against specified medical terms and diagnosis or procedure codes (without the need of interpretation) and follow established procedures for authorizing request or referring request for further review. ✓ To actively involved in Reimbursement and Auditing of claims submitted to Dubai Care. ✓ Taking calls, answering clients & providers’ inquiries ✓ Provide verbal approval for emergency cases thru hospital admissions ✓ Review of medical records for appropriate ICD-9, ICD-10, HCPCS codes. ✓ Answer questions related to insurance deductibles and co-pays, and coverage of the member under policy terms.

Federated States Of Micronesia

✓ Responsible for Nursing care ✓ Well skilled inpatient / outpatient care and needs assessment, dispensing prescribed medications, catheterization, charting and triage. ✓ Work closely with physicians and other healthcare staff to ensure optimal care. ✓ Handles patient documentation thru charting ✓ Thrive in both independent and collaborative work experience

Ncr - National Capital Region, Philippines

✓ Serves as Circulating and Scrub nurse with the following additional duties. ✓ Selects and handles instruments and supplies used for the operation, passing them to surgeon. ✓ Assists in positioning, responding to comfort/safety of patient ✓ Provides for accurate care and handling of specimens. ✓ Observes and enforces strict standards of asepsis. ✓ Observes, checks and monitors all equipment used during surgery to confirm they are running smoothly ✓ Inventories all items both pre- and post-surgery ✓ Selects and handles instruments and supplies used for the operation, passing them to surgeon

Region Iva - Calabarzon, Philippines

✓ Serving as Chairperson, Sports & Youth Development Action Officer ✓ Initiates programs and projects for sports and youth welfare and developmen

Region Iva - Calabarzon, Philippines

✓ Provides valuable services to the public, patients and their families. ✓ Single out medically needs in the local community. ✓ Conducting seminars and promoting good health in the community. ✓ Giving vaccinations to the newborns and children. ✓ Assisting the community Doctors in community patient care.

Bachelor Of Science (B.S.), Nursing

Activities and Societies: Performing Arts Guild of Fatima (PAGFA)

Secondary