Earl Porlay
Provider Service Representative
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About
Customer Service Professional with over four years of experience in the healthcare industry, dedicated to deliver exceptional client support. Proven ability to handle complex inquiries with empathy, efficiency, and professionalism. Currently seeking a growth-oriented organization that values continuous learning and career development, where I can contribute to team success while further enhancing my skills and advancing my career.
Experience
Provider Service Representative - Sagility Health Philippines
(2022-04 - 2026-07)
- Provided expert guidance to members on healthcare benefits, eligibility, and coverage for medical services, including office visits, diagnostic procedures, and treatments.
- Reviewed and communicated the status of insurance claims and appeals, ensuring members received timely, accurate, and clear updates throughout the resolution process.
- Investigated, analyzed, and resolved denied or disputed claims by identifying discrepancies, coordinating with members, and facilitating accurate claim adjudication.
- Supported healthcare providers by verifying CPT/HCPCS procedure codes, determining prior authorization requirements, and ensuring compliance with payer guidelines.
- Validated existing authorizations and confirmed approvals for covered medical services, helping ensure adherence to insurance policies and minimizing claim processing delays.
- Ensured patient records and documentation met HIPAA privacy and security requirements.
- Followed HIPAA guidelines when communicating, storing, and managing sensitive patient information.
Education
Diploma - Office Management Technology - Polytechnic University of the Philippines (2018 - 2020)
Guinayangan National High School (2009 - 2013)
Guinayangan Elementary School (2003 - 2008)
