Marilou Garcia
Winnipeg,MB
Summary
Results-driven professional with extensive experience in claims processing, proficient in interpreting and applying policies and procedures. Established a reputation for delivering top-level customer care in professional environments, leveraging exceptional oral and written communication skills. Recognized for exceptional organizational abilities to manage shifting priorities and ensure accuracy. Proven track record of making sound decisions, effective problem-solving, and working independently with minimal supervision.
Overview
9
9
years of professional experience
Work History
Claims Implementation Specialist
People Corporation
04.2022 - Current
- Lead and manage the implementation of new groups and convert existing clients to the TPA model, working with administration implementation specialists as well as advisors, account managers and underwriters
- Enter division and class level setting including HCSA
- Load plan design coverage details and benefit details into the claims adjudication platform
- Quality assurance of plan details and set up.
MIS Coordinator
Canada Life
09.2021 - 03.2022
- Monitored and assigned email inquiries sent to the shared claims referral mailbox
- Cancelled all online claims submitted in error
- Communicated and provided direction and instructions to fellow team members and internal departments
- Liaised with other departments regarding claim inquiries and concerns
- Provided CE (Claims Examiner) support.
Senior Group Benefits Examiner
Canada Life
07.2017 - 09.2021
- Analyzed and reviewed complex claims, reassessments, and adjustment requests
- Reviewed, investigated, and adjudicated Canadian health and dental claims in accordance with group policy contracts
- Conducted telephone calls to health and dental service providers for incomplete claims information
- Made accurate payment decisions according to adjudication guidelines
- Processed appeals, redistributions, and overpayments in line with set procedures and protocols.
Group Benefits Examiner
Canada Life
01.2016 - 07.2017
- Evaluated complex claims, reassessments, and adjustment requests to provide accurate assessments
- Reviewed, investigated, and resolved health and dental claims based on group policy contracts
- Communicated with health and dental service providers through telephone conversations to gather necessary information for incomplete claims.
- Made accurate payment decisions in accordance with adjudication guidelines
- Processed appeals, redistributions, and overpayments in line with set procedures and protocols.
Education
Bachelor in Computer Science -
Lyceum of the Philippines
Batangas City04.2001
Skills
- Implementation Management
- Work Planning and Prioritization
- Claims Processing and Evaluation
- File and Record Management
- Customer Support
- Administrative Oversight
- Analytical Skills
- Critical Thinking
- Written and verbal communication
- MS Office
Timeline
Claims Implementation Specialist
People Corporation
04.2022 - Current
MIS Coordinator
Canada Life
09.2021 - 03.2022
Senior Group Benefits Examiner
Canada Life
07.2017 - 09.2021
Group Benefits Examiner
Canada Life
01.2016 - 07.2017
Bachelor in Computer Science -
Lyceum of the Philippines
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