Clinical Operations Specialist - Transparent BPO
(2025-09)
- Provide telephonic nursing triage and on-call support for patients.
- Perform clinical research to identify and vet high-quality healthcare providers and facilities.
- Manage medical record requests, ensuring full adherence to HIPAA regulations and data privacy standards.
- Maintain data integrity by ensuring accurate and timely documentation within EMR systems.
- Proactively audit patient files to identify missing information and resolve gaps through follow-up.
- Facilitate coordination between insurance providers, clinical teams, and partners to streamline patient care.
- Optimize operational workflows by monitoring pending actions and ensuring strict adherence to deadlines.
- Drive process efficiency to enhance the overall quality of the patient journey and clinical outcomes.
Emergency Department – Head Nurse - Pasig Doctors Medical Center Inc.
(2022-01 - 2025-01)
- Supervise and mentor nursing staff by assigning duties, evaluating performance, and providing constructive feedback.
- Direct the onboarding and ongoing professional development of new nurses while fostering a collaborative and supportive unit culture.
- Optimize nursing schedules to ensure adequate staffing levels that consistently meet patient care requirements.
- Oversee medical supply and equipment inventory to ensure clinical readiness and resource availability.
- Lead the assessment of patient conditions and the development and implementation of individualized care plans.
- Drive the development and adoption of nursing practice policies and procedures to improve patient care standards.
- Facilitate interdisciplinary communication between physicians, clinical staff, and hospital administration to coordinate patient care and operational needs.
Customer Service Specialist - SPI CRM – REMITLY Account - Pasig City, NCR
(2016-01 - 2016-10)
- Manage inquiries regarding account activity via phone, email, and chat.
- Execute inward and outward international fund transfers with precision.
- Verify daily operations reports for local and international transfers, including ITRS, PSD, and other regulatory or management-required reports.
- Provide guidance to branch staff to ensure thorough understanding of remittance policies, as well as KYC, CDD, and EDD processes.
- Ensure all remittance processes strictly adhere to regulatory requirements and AML/CFT policies.
- Maintain professional and timely communication with correspondent banks regarding inquiries.
- Identify and escalate suspicious customer transactions to the Compliance Department for investigation.
- Perform additional operational duties as assigned by management to support departmental goals.
Technical Support Representative / Customer Retention Specialist - Concentrix Philippines – DISH Account - Quezon City, NCR
(2014-03 - 2016-01)
- Diagnose and resolve complex hardware and software issues using advanced technical tools.
- Provide Tier 1 IT support to non-technical users, ensuring clear communication and effective solutions.
- Troubleshoot and repair malfunctioning products independently, minimizing downtime for clients.
- Document all technical interactions and transactions accurately to maintain detailed service records.
- Manage high-volume call traffic promptly to minimize abandonment rates and maximize customer satisfaction.
- Deliver courteous and straightforward technical support, consistently fostering a positive customer experience.
- Proactively follow up with clients to ensure resolution and long-term satisfaction.
- Collaborate with team members to consistently meet or exceed service level agreements (SLAs).
- Engage users through website support and community forums, providing timely answers and guidance.
- Drive business growth by upselling products and negotiating contract renewals to retain clients.
- Facilitate new service activations and streamline the ordering process, including scheduling technician site visits.
- Support logistics by creating cases and claims for damaged, lost, or displaced packages.
- Contribute to product development by testing and providing feedback on new offerings.
- Maintain expert-level knowledge of emerging technologies and company product solutions.
Prior Authorization Specialist - Aditya Birla Minacs Philippines Incorporated – Healthcare Account - Quezon City, NCR
(2013-05 - 2014-03)
- Manage the end-to-end prior authorization process by preparing and submitting requests with required documentation to insurance companies.
- Evaluate authorization requests to ensure they align with medical necessity and specific insurance criteria.
- Maintain meticulous records of all authorization requests, approvals, and denials to ensure organizational transparency.
- Facilitate the resolution of denied authorizations by collaborating directly with the billing team.
- Support comprehensive medical billing tasks, including insurance claims submission, follow-ups, and payment processing.
- Ensure full compliance with HIPAA regulations while handling sensitive patient health information.
- Verify patient insurance eligibility and benefits to accurately determine coverage for proposed services.
- Act as a primary point of contact for patients, providing clear updates on authorization status and necessary next steps.
- Deliver high-quality customer service by addressing patient inquiries regarding procedures, services, and insurance coverage.
- Coordinate effectively between healthcare providers, insurance carriers, and patients to streamline the authorization workflow.
Customer Service Representative - Teleperformance Philippines – VIRGIN Mobile Account - Mandaluyong City, NCR
(2012-05 - 2013-05)
- Provide technical support for mobile devices by performing basic troubleshooting and diagnostics.
- Deliver a high-quality, elevated customer experience to build and maintain a loyal clientele.
- Resolve customer inquiries and complaints in a timely, professional, and empathetic manner.
- Manage inbound telephone communication by assisting customers and directing calls to appropriate departments.
- Streamline administrative and support tasks to ensure efficient issue resolution.
- Educate customers on product features, care instructions, and current promotional offers to drive sales.
- Utilize consultative selling techniques to successfully upsell products.
