Jose Kennedy Carandang
Summary
Medical Claims Review – Senior Analyst / Registered Nurse in Philippines
Exhibited success in over 3 years of work in hospital and health service and 10 years of Customer and Clinic Program Service in a Medical Insurance Company. Possess leadership and good coordination amongst staff and co-workers. Worked in flexible shifts, good coordination and teamwork, a seeker of knowledge and wisdom, goal-oriented individual, value driven and diligent person, skilled with patient care both in communication and physical support.
Overview
14
14
years of professional experience
4
4
years of post-secondary education
Work History
Medical Claims Review – Senior Analyst
Cigna Insurance Middle East SAL
and NAS-Neuron LLC, Dubai UAE
06.2017 - 06.2023
- Provide medical review/consulting for escalated claims, appeals, etc.
- Responsible for the application of medical and reimbursement policies within the claim adjudication process
- Working within the Provider Assistance contact center, investigate, consider and pre-authorize treatment within Qatar, Bahrain, Oman, and Kuwait.
- Professionally manage inbound telephone, and email; correspondence with customers, brokers, suppliers and all other interested parties ensuring that appropriate and timely communication is always maintained.
- Complete eligibility verification, escalate medical information to Clinical Case Managers, determine coverage, identify discrepancies, and apply all cost containment measures including identification of opportunities for subrogation and recovery.
Customer Service Consultant
Aetna Global Benefits (Middle East) LLC
, Dubai, UAE
08.2015 - 05.2017
- Working within the Member Assistance contact centre, investigate, consider and pre-authorize treatment globally.
- Professionally manage inbound and outbound telephone, fax and email; correspondence with customers, brokers, suppliers and all other interested parties ensuring that appropriate and timely communication is always maintained.
- Complete eligibility verification, escalate medical information to Clinical Case Managers, determine coverage, identify discrepancies, and apply all cost containment measures including identification of opportunities for subrogation and recovery.
- Triage and prioritize caseload considering urgency, geographical location and service level.
- Take ownership for progression of own caseload, maintain communication, remove barriers, avoid delays.
Medical Authorization Executive Outpatient
Neuron Insurance - Third Party Administrator
, Dubai, UAE
06.2013 - 07.2015
- Responsible for providing authorizations or responding to all inquiries; by providing information or directing requests to others who can supply the necessary information or service.
- Answer all incoming calls related to general enquiries on insurance policies following the Company guidelines and protocols.
- Assisting medical providers (hospitals/clinics/pharmacies) and customers on the pre-approval follow up cases.
- Routing calls to various departments depending on the requirement of the call.
- To ensure that the Team Senior or the Manager become aware of possible high-cost approvals.
- Updating self on the new groups, any amendments to the existing policies, about the addition, renewal and removal of groups for the insurance companies
- Handle calls from Hospitals, Clinics, Pharmacy and patients by ensuring a resolution is achieved.
Critical Care Unit - Assistant Head Nurse
DANIEL MERCADO MEDICAL CENTER
, Philippines
02.2009 - 11.2012
- We are responsible for monitoring the health of patients in intensive care.
- Aid and treat patients suffering from a wide variety of illnesses and injuries, most of which are potentially life threatening.
- Performs treatments, delivers medications and work with doctors and patients to ensure treatments are followed.
- Closely monitoring the health of patients, ready to respond to emergency situations and be able to provide appropriate care at a moment's notice.
- Specialized in treating adult, geriatric, pediatric patients, as treatment differences between the groups can vary greatly.
Education
Bachelor of Science - Nursing
Centro Escolar University
Manila, Philippines 06.2003 - 03.2007
Skills
- Excellent verbal and communications skills
- Good observation and assessing and giving nursing care to patient needs
- MS office applications
- Ability to work with a team and focus on individual tasks accordingly
- Adapts and learns fast to the given trainings
Timeline
Medical Claims Review – Senior Analyst
Cigna Insurance Middle East SAL
06.2017 - 06.2023
Customer Service Consultant
Aetna Global Benefits (Middle East) LLC
08.2015 - 05.2017
Medical Authorization Executive Outpatient
Neuron Insurance - Third Party Administrator
06.2013 - 07.2015
Critical Care Unit - Assistant Head Nurse
DANIEL MERCADO MEDICAL CENTER
02.2009 - 11.2012
Bachelor of Science - Nursing
Centro Escolar University
06.2003 - 03.2007
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