WILFREDO CONTRERAS

Royal Caribbean Group

Shoreside Case Manager – Crew Medical Department

• Crew Member's Case Manager

• Lead port agents and crew members in different countries

• Instruct port agents with work and follow up instructions

• Follow up on Emergency disembarkation and Hospital admission

* Excellent Customer Service Skills

* Good Listener

• Relocate crew members in Hotels after hospitalization discharge

• Review medical records and medical diagnosis

• Follow up with hospital admission or outpatient procedures

• Review Health Benefits and Coverage

•Coordinate Air Ambulance Evacuation in different ports of Landing

•Request hospitalization admission with in network hospitals

•Maintain close communication via email or telephone with crew members - patients while Hospitalized

•Request medical records from port agents or assigned network agency

•Review medical cases with management and medical team on complex medical cases

*Work independently

•Good Team -player

Norwegian Cruise Lines

• Repatriation Case Manager - International– Crew Medical Department
• Crew Member's Case Manager
• Lead port agents and crew members in different countries
• Instruct port agents with work and follow up instructions
• Follow up on Emergency disembarkation and Hospital admission
• Relocate crew members in Hotels after hospitalization discharge
• Review medical records and medical diagnosis
• Follow up with hospital admission or outpatient procedures
• Review Health Benefits and Coverage
• Review disembarked Crew Member discharge medical notes
• Assigned crew members to Medical Facility depending on Medical Diagnosis
• Make sure Crew Member received medical care as indicated by initial Medical Doctor
• Make sure crew member conclude medical treatment and received Fit to Return to Work
• Request medical records from port agents or assigned network agency
• Review medical cases with management and medical team on complex medical cases
• Work independently
• Good Team -player

Bupa Latin America , Palmetto, FL

• Managed large volume of medical claims on daily basis.
• International Claims Adjudicator – Latin America, Caribbean, Europe, South America
• Review Medical Reports Review Pre-existing conditions for fraudulent claims
• Respond Emails to Agents in regards to claims status in a timely manner
• Negotiate Hospitalization fees for high bills cost Apply UCR for International
• Hospital Bills Apply UCR for Doctors Medical Fees Review CPT Codes for International Claims Review
• ICD 10 Diagnosis for International Claims Deny
• Reviewed provider coding information to report services and verify correctness
• Managed large volume of medical claims on daily basis
• Responded to correspondence from insurance companies
• Paid or denied medical claims based upon established claims processing criteria