Summary
Overview
Work History
Education
Skills
Professional Qualifications
Languages
Timeline
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Bea Mitzie Castelo

Edmonton,AB

Summary

Productive Insurance Claims Professional with strong Medical background. Enthusiastic about helping patients get necessary medical support by obtaining authorizations and coordinating paperwork. Detail-oriented and proactive with good relationship-building skills, a hardworking nature and an adaptable approach. With valuable on the job trainings and exposure on Retail and Hospital Pharmacy as well as Manufacturing. Proficient in Microsoft Office applications.

Overview

6
6
years of professional experience

Work History

Reimbursement Claims Processor

ARAB GULF HEALTH SERVICES (NEXTCARE)
11.2011 - 10.2013
  • Review and process out of network claims as per Insurance policy
  • Checks all documents required for processing claim
  • Enter all details of the member on the system
  • Confirm eligibility and review previous utilization of the member before processing
  • Reports fraudulent and duplicate claim to supervisors.

Claims Communication

ARAB GULF HEALTH SERVICES (NEXTCARE)
06.2009 - 10.2011
  • Handles all kind of email inquiries
  • Provides explanation of benefit, claim history and denial reason
  • Update payers on claim status
  • Handles complaints with regards to policy issues and medical eligibility
  • Assist VIP member on consultation and treatment outside the country
  • Provides pre-authorization on urgent claim requested by payers
  • Communicates with international providers and clients.

Medical Claims Secretary

ARAB GULF HEALTH SERVICES (NEXTCARE)
08.2007 - 05.2009
  • Main Duty is to enter all claims on the system before evaluation
  • Answers phone inquiries related to claims (follow-ups and claim status)
  • Enter all details regarding the patient on the system (patient name, diagnosis and treatment plan)
  • Coordinates with providers with regards to the medical reports
  • Print and save all incoming faxes
  • Distribute claims for evaluation.

Education

Bachelor of Science in Pharmacy

Centro Escolar University
Manila Philippines
04.2003

Skills

  • Customer Service Experience
  • Effective Communication
  • Insurance Knowledge
  • Complaint Resolution
  • Schedule Coordination
  • Business Correspondence
  • Child Supervision
  • Written Communication
  • Data Entry

Professional Qualifications

Licensure Examination for Pharmacist in the Philippines, 01/2004

Languages

English
Full Professional

Timeline

Reimbursement Claims Processor

ARAB GULF HEALTH SERVICES (NEXTCARE)
11.2011 - 10.2013

Claims Communication

ARAB GULF HEALTH SERVICES (NEXTCARE)
06.2009 - 10.2011

Medical Claims Secretary

ARAB GULF HEALTH SERVICES (NEXTCARE)
08.2007 - 05.2009

Bachelor of Science in Pharmacy

Centro Escolar University

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Bea Mitzie Castelo