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Ramil F. — Mid-Level Healthcare Claims Specialist from Philippines

Ramil F.

Mid-Level Healthcare Claims Specialist

Philippines No experience yet
Open to offersNew to Platform
Languages
English
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About

Ramil R. is an accomplished professional with extensive experience in the healthcare and sales sectors. Educated at the Samson Institute of Technology, he completed a Diploma Vocational Course and pursued studies in Electrical Engineering. In his most recent role as a Senior Advocates Representative at NTT DATA associated with Blue Cross Blue Shield of Arizona, Ramil excelled in insurance verification, handling complex tasks such as obtaining prior authorizations and managing claim denials. His career also includes a long tenure as a Customer Service Representative at Hinduja Global Solutions for Cigna Healthcare, where he specialized in claims and benefits verification and providing resolutions for claims issues. Prior to this, Ramil's experience in the UAE includes serving as a Sales Manager and Senior Sales Executive in the interior design industry, where he led marketing efforts, managed client relationships, and ensured project completion to satisfaction. His robust skill set in MS Office and adaptability under pressure have made him a valuable asset in every position he has held.

Experience

  • Senior Advocates Representative

    NTT DATA – (BCBS) Blue Cross Blue Shield Of AZ Healthcare · 2024 — 2026
    Performed insurance verification to confirm member coverage eligibility by contacting insurance carriers. Managed prior authorizations for various treatments as required by insurance plans. Reviewed claim denials to understand reasons and gathered necessary documentation for appeals. Assisted members with coverage inquiries and payment details. Engaged in collections by reaching out to customers and insurance companies for overdue payments. Tracked patient revenue from appointment through to payment, ensuring accurate reimbursement for services.
  • Customer Service Representative

    Hinduja Global Solutions (HGS) - Cigna Healthcare · 2019 — 2024
    Conducted verification of members' insurance eligibility and provided guidance on claims and benefits. Addressed provider inquiries regarding eligibility and coordination of benefits. Delivered accurate denial reasons and resolved issues by submitting additional documentation or appeals when necessary.
  • Sales Manager

    RWK German Kitchen & Interiors · 2009 — 2014
    Managed marketing efforts for the company's products and services by engaging with construction sites and scheduling meetings with prospective clients. Fostered strong relationships with clients, consultants, and contractors throughout project phases. Handled the preparation of documentation for prequalification and bidding, representing the company in negotiations. Collaborated with designers to create custom designs to meet client specifications and monitored project timelines to ensure successful completion.
  • Senior Sales Executive

    Royal House Interiors/Kitchen & Furniture’s · 2006 — 2009
    Executed direct marketing of company products and services to new clients, contracting firms, and consultants. Compiled pre-qualification documents and provided comprehensive support to clients from project initiation to completion. Oversaw the carpentry work to ensure quality standards were met throughout the project lifecycle.
  • Business Development

    Al Hafidth Kitchen & Wardrobes · 2005 — 2006
    Introduced the company's products and services to potential clients. Prepared material samples and prequalification documents for submission to clients.

Skills & Expertise

Education

  • Diploma Vocational Course
    Samson Institute of Technology · 1991 — 1992
  • Undergraduate in Electrical Engineering
    Samson Institute of Technology

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