Summary
Overview
Work History
Education
Skills
References
Timeline
EDEN MORES

EDEN MORES

Bitungol Norzagaray,Philippines

Summary

Dedicated professional with expertise in claims and billing support, adept at managing time efficiently and resolving conflicts. Proven track record in delivering exceptional customer service, handling escalations, and explaining insurance benefits. Skilled in eligibility verification, authorisation status review, and ensuring HIPAA compliance while maintaining accurate call documentation. Committed to leveraging skills in a dynamic environment to enhance operational efficiency and customer satisfaction.

Overview

17
17
years of professional experience

Work History

Healthcare Advocate /Member Sevices

CONCENTRIX
09.2025 - 07.2026
  • Explained plan benefits, authorization status, provider networks, and member services, enhancing member knowledge and satisfaction.
  • Assisted Highmark members with inquiries about health insurance benefits, eligibility, claims, and coverage, ensuring clarity and understanding.
  • Accessed member accounts, verified benefits, reviewed claims and authorization status, and documented interactions, providing comprehensive support.
  • Protected member information while complying with HIPPA and company policies.
  • Maintained quality productivity and customer satisfaction standards.

Inside Sales Representative

AFNI PHILS INC
Quezon City
05.2025 - 07.2025
  • Promoted products and services while identifying customer needs.
  • Build rapport with customer and recommended suitable solutions.
  • Achieved sales and performance goals while maintaining excellent customer satisfaction.
  • Accurately documented customer interactions and sales activities.
  • Ensured compliance with company policies and quality standards.

Property Management Helpdesk

OCS QATAT LLC
Doha, Qatar
08.2016 - 07.2018

Provided daily tenant and client support for urgent service needs.

Completed routine safety and habitability checks, documenting issues and follow-ups.

Coordinated maintenance requests and tracked progress until resolution for residents.

Guided prospective tenants with leasing information and next-step instructions.

Healthcare Advocate ( provider services)

Xerox (Humana)
Pasay, Philippines
03.2013 - 03.2015

Provided accurate answers about healthcare products and services for customers.

Advised on health insurance eligibility and benefits through structured conversations.

Owned customer record updates and documented inquiries for next-step follow-up.

Healthcare Specialist (Provider)

Teletech Customer Care
Pasay, Philippines
06.2011 - 12.2012
  • Reviewed health insurance plan details to guide providers on coverage choices.
  • Handled provider inquiries with accountable follow-through to resolve concerns.
  • Maintained customer records with strict accuracy standards for every case.

Technical Support Representative

TELUS INTERNATIONAL
Taguig, Philippines
07.2010 - 01.2011
  • Delivered technical support for hardware and software, maintaining service standards.
  • Owned diagnosis and resolution of technical issues using structured troubleshooting methods.
  • Coordinated with customers during troubleshooting to reach accurate, workable outcomes.

Inbound Sales Agent

SITEL PHILS ( Virgin Mobile)
Ortigas, Philippines
02.2009 - 06.2010
  • Recommended products based on customers needs
  • Managed customer inquiries and follow up request
  • Achieved sales and customer service goals

Education

Bachelor of Arts - Political Science

Divine Word College of
01-2002

Skills

  • Claims and billing support
  • Time management
  • Conflict resolution
  • Customer service
  • Escalation handling
  • Insurance benefits explanation
  • Eligibility verification
  • Authorization status review
  • HIPAA compliance
  • Call documentation

References

  • Charise Ninon

Customer Service Representative

Afni

contact : 09950917027

Sarmima Mambao

CSR CONCENTRIX

contact : 09306920705

email : minamambao@gmail.com

Timeline

Healthcare Advocate /Member Sevices - CONCENTRIX
09.2025 - 07.2026
Inside Sales Representative - AFNI PHILS INC
05.2025 - 07.2025
Property Management Helpdesk - OCS QATAT LLC
08.2016 - 07.2018
Healthcare Advocate ( provider services) - Xerox (Humana)
03.2013 - 03.2015
Healthcare Specialist (Provider) - Teletech Customer Care
06.2011 - 12.2012
Technical Support Representative - TELUS INTERNATIONAL
07.2010 - 01.2011
Inbound Sales Agent - SITEL PHILS ( Virgin Mobile)
02.2009 - 06.2010
Divine Word College of - Bachelor of Arts, Political Science
EDEN MORES