Mark Milton Vibal

Detail-oriented and highly organized Virtual Assistant with over 10 years of experience in administrative support, healthcare claims processing, customer service, and operations management. Proven expertise in order triage, document management, medical fraud detection, and regulatory compliance (HIPAA). Proficient in managing complex schedules, processing orders for DME and transportation, and maintaining seamless communication across teams.

CLAIM SPECIALIST - EXL - 6th floor One E-com, Mall of Asia Pasay City

• Verifying patient's eligibility
• Reviewing the claim filed by an insurance holder
• Provide specific benefits based on their claim form and medical documents
• Processing payments for healthcare providers, ensuring accurate claim submissions and patient payments
• Creating and sending a letter of Explanation of Benefits to the insurance holder
• Making an outbound call to the medical provider and hospitals to verify date and type of services
• Knowledge about ICD-10, HCPCS, CPT code
• Strictly follow the HIPPA and HPI

ORDER TRIAGE SPECIALIST

• Managed order triage for transportation appointment entries; generated and processed requests for Imaging, Durable Medical Equipment (DME), and Specialty DME initiated by insurance adjusters
• Reviewed medical records and claim forms to identify potential medical fraud; organized, indexed, and renamed incoming electronic documents according to strict company naming conventions
• Reply to email professionaly

CUSTOMER SERVICE REPRESENTATIVE - C3 - Everise Philippines - 11th Floor • Bonifacio One Technology Tower • 31st St. corner Rizal Drive • Bonifacio Global City

(2021-08 - 2022-10)

• Answering call from insurance holder
• Provide accurate answer to customer's inquiry regarding on their insurance
• Contributes to team effort by accomplishing related results as needed
• Communicating and coordinating with colleagues as necessary
• Providing feedback on the efficiency of the customer service process
• Document the problem, action and the resolution given to the customer

Bachelor of Secondary Education - English Language - CAVITE STATE UNIVERSITY (2014 - 2020)