Milet Dire

Passionate and dedicated educator with 13 years of experience teaching preschool and primary school students. Skilled in creating engaging lesson plans and implementing interactive learning activities that enhance student learning and development. Recognized for fostering a positive and inclusive classroom environment, integrating music and arts into the curriculum, and mentoring students for academic success.

Preschool and Elementary Teacher - New Hope To Asia - 273 Sunset Drive Cor New York St., Brookside Hills Subdivision, Brgy. San Juan, Cainta, Rizal

(2013-03)

Handling 16 students in both Preschool and Grade 1-3.

• Designed and implemented comprehensive lesson plans tailored to the diverse learning needs and interests of kindergarten and elementary students.
• Established a nurturing and stimulating classroom environment that fosters active participation, collaboration, and creative expression.
• Employed a variety of instructional strategies, including hands-on activities, technology integration, and differentiated instruction, to enhance student comprehension and engagement.
• Assessed student progress through formative and assumptive evaluations, providing constructive feedback and individualized support to optimize learning outcomes.
• Maintained open and effective communication with parents and guardians, offering regular progress updates and addressing any concerns to ensure student success.
• Collaborated with colleagues and school administrators to plan and execute school-wide programs, events, and extracurricular activities that enrich the student learning experience.

Benefit Explanation & Guidance / Claims Adjudication Support & Resolution / Provider & Member Advocacy - Legato Health Technologies

(2021-08-30 - 2022-03-19)

• Benefit Explanation & Guidance: Answer inbound inquiries from members and healthcare providers to explain coverage details, including deductibles, copays, coinsurance, out-of-pocket maximums, and prior authorization requirements.
• Claims Adjudication Support & Resolution: Review, research, and troubleshoot denied, pending, or incorrectly processed medical claims. Coordinate with the billing and coding teams to resolve discrepancies.
• Provider & Member Advocacy: Act as a liaison between patients and medical providers to resolve billing disputes, correct medical coding errors (using ICD-10, CPT, and HCPCS knowledge), and ensure accurate reimbursement.
• Navigate Complex Care Networks: Verify in-network vs. out-of-network status for providers and facilities, helping members maximize their benefits and avoid unexpected out-of-pocket costs.
• Strict Regulatory Compliance: Maintain absolute confidentiality and data integrity by adhering to HIPAA (Health Insurance Portability and Accountability Act) guidelines and other healthcare regulatory standards.
• Accurate Documentation: Document all interactions, claim histories, and resolutions thoroughly within the Customer Relationship Management (CRM) and electronic health record systems.

Preschool Teacher - Hope Academy - 593 St Christopher St., Brookside Hills Subdivision, Cainta, Rizal

(2012-06 - 2013-03)

• Participated in parent-teacher conferences to discuss student achievements, behavior, and areas of improvement.
• Adapted to teaching methods and materials to meet the interests and learning styles of children.

Bachelor of Secondary Education - Technological and Livelihood Education - University of Rizal System (2007 - 2012) Cainta, Rizal