Maritess D.
Mid-Level Health Insurance Claims Associate
Open to offersNew to PlatformAbout
Maritess D. is an experienced Process Associate at Genpact Services, Inc., with a focus on case management and issue resolution in a business process outsourcing environment. Since March 2025, she has collected, documented, and validated incident and customer feedback information, investigated cases by analyzing system data and logs, and reproduced user-reported issues to support troubleshooting. Previously, she was a Business Process Delivery Associate and Health Operations Associate at Accenture, Inc., where she processed medical and dental insurance claims, ensured compliance with provider contracts, and handled claim appeals and correspondence. Her expertise extends to claim analysis, case documentation, and proficiency in Microsoft Office applications. Maritess D. holds a Bachelor of Business Administration from the Polytechnic University of the Philippines with a major in Human Resource Development Management.
Experience
Process Associate
Genpact Services, Inc · 2025 — PresentCollected, documented, and validated information concerning reported issues, incidents, and customer feedback by adhering to intake and case-management protocols. Investigated reported cases by examining system data, logs, and user input to determine root causes and gather pertinent information for assessment and resolution. Reproduced reported system bugs by replicating user environments and actions to verify defects and aid in troubleshooting.Business Process Delivery Associate / Health Operations Associate
Accenture, Inc. · 2016 — 2025Handled medical and dental insurance claims by collecting, reviewing, analyzing, and processing submissions in accordance with company policies, provider contracts, and adjustment guidelines. Evaluated claim accuracy, completeness, eligibility, and coverage and determined when further authorization or review was needed. Prepared written requests for additional documentation and referred complex claims for further inquiry. Processed clinical appeal cases, screened non-clinical data, and transferred pertinent information to clinical staff to support medical necessity reviews. Maintained communication with claimants, providers, employers, and case managers and participated in cross-functional collaboration to facilitate compliant claim and appeal resolutions.
Skills & Expertise
Education
- Bachelor of Business Administration Major in Human Resourced Development ManagementPolytechnic University of the Philippines · 2012 — 2016
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