Experience

Further Group

• Spain
• Insurance
• 1 - 100 Employee

• • May 2021 - Present

  -Team management: planning and coverage of vacations, distribution of workload, schedule supervision-Assist and arrange periodical meetings with the team and peers to get feedback to improve the service-Participate in improving the process. Automation, simplification, working with test cases, efficiency Improve quality of the service provided to the customers-Supervision of TPAs and SLA adherence to operational processes as per agreement-Conducting training sessions on claims management procedures-Reduce the number of issues and complaints of our customers-Upper-level escalation, complex cases & complaints management-Enhancing Claims data consistency & quality-Assessment of the case coordinators performance and adequate workload distribution in coordination with the Claims Team Manager-Control of claims expenses register in coordination with finance team to ensure money transfers match the movements on bank accounts-Assistance to Customer Operations Manager with ad hoc projects and new implementations-Responsible for protecting all data you are working with, preventing any unauthorized /inappropriate access, unlawful use, disclosure, disruption, deletion, corruption, modification, inspection, recording, or devaluation of the information.- Billing: resolving incidents with expenses and doubts of coverage Show less

• • Nov 2019 - Apr 2021

  -Provide support to incoming cases and confirm policy, as well as medical eligibility according to internal process-Coordinate and provide access to the best specialists and health care providers in a timely and effective manner-Support the insured member to understand the products, process, and clinical journey Interact directly with Customers and Families along the Customer journey for intake interviews and others, keeping track of their progress and ensuring satisfaction-Provide support to Claimants, Clients and Providers via phone, chat, email, digital platforms or other as per communication standards-Organize internally with Medical Panel and externally with Medical Providers to establish a clear pathway for treatment recommendation and consequent services - Review medical reports and treatment plans and control medical costs triggering the appropriate level of authorizations-Handle assigned cases, draft service plans, review case progress and determine case closure-Help insured members make informed decisions by acting as their advocate regarding their clinical status and treatment options-Develop effective working relations and cooperate with internal Teams and colleagues, especially the medical team throughout the entire case management process-Collaborate and coordinate with international TPA's wherever and whenever applicable.- Maintain all case records completed and up to date within internal systems (i.e., record case information, complete accurately all necessary forms, produce reports...) Adhere to professional standards as outlined by protocols, rules, and regulations -Responsible for protecting all data you are working with, preventing for any unauthorized/inappropriate access, unlawful use, disclosure, disruption, deletion, Show less



Universidad Europea

• Spain
• Education Management
• 700 & Above Employee

• Gestor en departamento Atención al Estudiante

  • Jun 2019 - Sep 2019

  - Atención a los estudiantes matriculados mediante consultas telefónicas (inglés, español), así como gestión y coordinación de mensajería - Soporte administrativo - Apoyo a varios departamentos de la universidad (facturación, matriculación, secretaría académica, etc.) con labores de administración backoffice y elaboración de informes - Resolución de posibles incidencias - Manejo de herramientas informáticas de la universidad (plataformas online, CRM, páginas web, Campus Virtual) - Atención a los estudiantes matriculados mediante consultas telefónicas (inglés, español), así como gestión y coordinación de mensajería - Soporte administrativo - Apoyo a varios departamentos de la universidad (facturación, matriculación, secretaría académica, etc.) con labores de administración backoffice y elaboración de informes - Resolución de posibles incidencias - Manejo de herramientas informáticas de la universidad (plataformas online, CRM, páginas web, Campus Virtual)



AcademSpain S.L.

• España

• Auxiliar administrativo

  • Oct 2018 - May 2019

  - Soporte administrativo - Organización de las reuniones online con los clientes - Búsqueda y sistematización de los programas educativos - Traducción español-ruso, inglés-ruso, inglés-ruso, ruso-inglés de toda la información necesaria para los clientes y socios de la empresa - Creación de campañas de marketing vía email e identificación de clientes potenciales - Reuniones presenciales con los clientes y socios si éste se encuentra en Madrid - Soporte administrativo - Organización de las reuniones online con los clientes - Búsqueda y sistematización de los programas educativos - Traducción español-ruso, inglés-ruso, inglés-ruso, ruso-inglés de toda la información necesaria para los clientes y socios de la empresa - Creación de campañas de marketing vía email e identificación de clientes potenciales - Reuniones presenciales con los clientes y socios si éste se encuentra en Madrid