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anjanette O. — Mid-Level Risk Operations Analyst from Philippines

anjanette O.

Mid-Level Risk Operations Analyst

Philippines 2-3 years
Open to offersNew to Platform
Languages
English
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About

Anjanette O. is a highly adaptable and detail-oriented professional with extensive experience in the healthcare insurance industry, focusing on claims processing, quality assurance, reconciliation, and risk operations. Her education in BS Psychology from Centro Escolar University provided a strong foundation for her career. She has demonstrated proficiency in handling medical and financial claims, with expertise in auditing, reporting, and account validation. Her professional journey includes roles at esteemed companies such as Ubiquity Global Services Inc., Maxicare Healthcare Corporation, and AIA Philippines Life and General Insurance Company Inc. In these roles, she has excelled in managing insurance claims, conducting fraud and error investigations, and ensuring the accuracy of account plans. Currently, as a TPA Claims Processor, she reviews and validates medical insurance claims, processes billing invoices, and coordinates with internal teams. Her strong analytical, organizational, and communication skills enable her to work effectively in fast-paced environments.

Experience

  • TPA Claims Processor

    AIA Philippines Life and General Insurance Company Inc. · 2025 — Present
    Reviewed and validated medical insurance claims and billing documents. Processed billing invoices and reconciled claim discrepancies. Prepared reports while coordinating with internal teams and vendors, and addressed claim-related concerns.
  • Risk Operations Analyst / Quality Auditor/Talent Acquisition Specialist

    Accenture Inc. · 2019 — 2024
    Utilized case management processes for handling fraud and error allegation claims through an end-to-end process. Audited dispute cases handled by agents and generated calibration reports. Conducted pre-screening for applicants.
  • Data Analyst/Examiner

    Ubiquity Global Services Inc. · 2017 — 2019
    Reviewed and investigated claims for adjustments, remittance, or denial. Managed insurance claims from patients and doctors' offices, ensuring validity. Analyzed and verified the accuracy and completeness of claims.
  • Processor/Quality Assurance

    Maxicare Healthcare Corporation · 2016 — 2017
    Received and validated account endorsements. Created and updated account information and plans, finalized APD set-up, and conducted quality assurance on drafted documents. Generated daily reports and monitored accounts.
  • Admin Staff/Marketing Staff

    Borough Medical Inc. · 2014 — 2015
    Received, checked, and validated endorsements and letters of authorization from companies. Engaged in reporting and visiting clients as well as external agencies.

Skills & Expertise

Education

  • Bachelor of Science in Psychology
    Centro Escolar University · 2010 — 2014
  • Secondary School
    Gracel Christian Academy · 2006 — 2010