Ma. Divina S. Malabanan
Lemery,Philippines
Summary
Experienced CSR IB/OB Sales agent for Health Care Insurance for more than 8 yrs
Personable and detail-oriented professional with strong foundation in customer service and healthcare administration. Possesses in-depth understanding of prescription benefit management systems and proficiency in data entry and claims processing. Dedicated to optimizing patient access to medications and enhancing overall healthcare experiences.
Developed expertise in prescription benefit management within fast-paced healthcare environment, focused on accuracy and efficiency. Skilled in data analysis, problem-solving, and process optimization. Seeking to transition into new field, leveraging strengths in administration and customer service to drive impactful results.
Overview
11
11
years of professional experience
Work History
Prescription Benefit Specialist
Mochi Health
01.2024 - 01.2025
- Navigated complex billing systems with ease, ensuring accurate invoicing and prompt payment collection from insurers.
- Developed strong relationships with pharmaceutical representatives to stay informed about new products and industry updates.
- Supported pharmacists in providing optimal patient care, handling insurance claims, and managing medication inventory.
- Contributed to increased revenue by identifying potential clients for the company''s prescription benefit management services.
INBOUND/OUTBOUND SALES AGENT
MORGAN FIDELITY ASSOCIATES (MFA)
01.2022 - 01.2024
- Taking outbound /inbound calls and refer the lead to a license agent to check other Medicare insurance options and maximize their medical benefits
- Assisting callers/leads in reducing their tax debts
- Pre-qualify leads and provide free no obligation consult with the license insurance agent to determine if they're getting their benefits at the lowest cost
INBOUND/OUTBOUND SALES AGENT
TRANSPARENT BPO PHILIPPINES (TBPO)
01.2020 - 01.2022
- Taking outbound /inbound calls and refer the lead to a license agent to check other Medicare insurance options and maximize their medical benefits
- Assisting callers/leads in reducing their tax debts
- Pre-qualify leads and provide free no obligation consult with the license insurance agent to determine if they're getting their benefits at the lowest cost
CUSTOMER SERVICE REPRESENTATIVE / BACKOFFICE AGENT
THE RESULTS COMPANIES
01.2015 - 01.2020
- Verification Process
- Check members application is approved or denied
- Help members in setting up an appointment regarding transportation and Primary care visit
- Help members in coordinating with their doctors regarding authorization and check if its approved or denied
- Check the bill and claims if the doctors properly submitted the members bill and if its paid or not
- Back Office Agent- escalate the member complaints and check how the agent handle the call and check for the opportunities found to provide resolution
- Listening to call recording and checking for opportunities to provide resolution to the member complaints
CUSTOMER SERVICE REPRESENTATIVE
Teletech-LIPA
01.2014 - 01.2015
- Furnishing members and health care practitioners with details regarding members' benefits
- Granting pre-authorizations for medical treatment, if covered
- Advising members of outstanding copayments
- Providing prospective members with the details of network providers
- Check if authorization is required or not
Education
BTTC ALITAGTAG
01.2020
BS - Accountancy
PHILIPPINE WOMEN'S UNIVERSITY
01.2003
Skills
- Problem-Solving
- Computer Literacy
- Strong Communication
- Prior authorization
- HIPAA compliance
- Claims processing
- Pharmacy benefit management
- Healthcare industry
- Software navigation
- Drug utilization review
- Formulary management
- Prescription drug plans
- Medicare part D
- Teamwork
- Medication authorization
- Teamwork and collaboration
- Problem-solving
- Time management
- Attention to detail
- Leadership skills
- Multitasking
- Multitasking Abilities
- Problem-solving abilities
- Reliability
- Excellent communication
- Critical thinking
- Active listening
Timeline
Prescription Benefit Specialist
Mochi Health
01.2024 - 01.2025
INBOUND/OUTBOUND SALES AGENT
MORGAN FIDELITY ASSOCIATES (MFA)
01.2022 - 01.2024
INBOUND/OUTBOUND SALES AGENT
TRANSPARENT BPO PHILIPPINES (TBPO)
01.2020 - 01.2022
CUSTOMER SERVICE REPRESENTATIVE / BACKOFFICE AGENT
THE RESULTS COMPANIES
01.2015 - 01.2020
CUSTOMER SERVICE REPRESENTATIVE
Teletech-LIPA
01.2014 - 01.2015
BS - Accountancy
PHILIPPINE WOMEN'S UNIVERSITY
BTTC ALITAGTAG
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