Lilibeth Joaquin-Gonzales Email & Phone Number

Singapore

Singapore

Singapore

Singapore

• Lead a team of claim executives to meet Pacific Prime-CXA’s service level agreements with clients
• Audit team member’s work to ensure accuracy in accordance with clients’ specification and requests
• Review team member’s payroll before sending out to clients
• Generate, prepare and submit General Interbank Recurring Order (GIRO) payment and MediSave reimbursement
• Reconcile data (Payroll, GIRO report, MediSave report) to ensure accuracy of reimbursed amount
• Handle high dollar value and complex claims escalated by team members

Singapore

• Verify submission of claims to ensure that information and documents are in order
• Adjudicate claims in accordance with clients’ specification and requests within stipulated timeline
• Liaise with Employees and HRs for submission of missing and incomplete information and documents
• Generate and prepare payroll files for team manager's checking
• Respond to phone calls and emails enquiries by employees and HR in timely manner

Philippines

• Handle complex claims transferred by Operations and Medical Review Analyst
• Conducts retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
• Review and analysis of post service claims utilizing the member’s benefit contract and health plan guidelines.
• Completes review of out-patient, in-patient, radiology, and laboratory services for Medical Necessity
• Utilizes client specific criteria sets, applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to Client’s medical staff for review
• Conducting any utilization or medical management review activities which require the interpretation of clinical information but excludes denial determinations.

Philippines

• Handle customers incoming calls.
• Attracts potential customers by answering product and service questions, suggesting information about other products and services
• Opens customer accounts by recording account information
• Maintains customer records by updating account information
• Resolves product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment.
• Maintains financial accounts by processing customer adjustments. Recommends potential products or services to management by collecting customer information and analyzing customer needs

Philippines

• Provide health assessment.
• Maintains and updates school health records
• Develops and implements a health plan
• Arrange and maintain a confidential daily register of students and staff attending the clinic
• Liaises between the School and staff and students about school health related issues
• Assists in sending out notices about school related health issues

Philippines

• Admit as well as carry out discharge procedure as needed utilizing the nursing process
• Formulates and writes an initial assessment to identify needs of patients
• Plans, administer and evaluate nursing care
• Carries out doctor’s orders in conformity with hospital policies and legal limitations
• Observes changes in patients and reports findings to physician in timely manner
• Makes endorsement report on patient’s conditions, unit supplies, equipment, medications and incidents to the head nurse and in-coming staff nurse