Rei Mon Ong Espejo is applying for the position of Medical Claims Processor and Medical Claims Assessor/Insurance Coordinator. He has over 6 years of experience in claims processing and assessment in Dubai. He believes his strong technical skills and education make him a competitive candidate. He is currently a Senior Medical Claims Processor/Assessor at Inayah TPA LLC and has also worked at Arab Health Gulf Services as a Medical Claims Processor/Assessor. He has experience accurately processing claims, assessing benefits, auditing invoices, and maintaining patient confidentiality.

1. Dear Sir/ Ma’am,
I am writing to apply for the Medical claims processor and Medical claims Assessor /
Insurance Coordinator position or any suitable job that I can apply my knowledge. As
requested, I am enclosing a completed job application and my curriculum vitae.
The opportunity presented in this listing is very interesting, and I believe that my
strong technical experience and education will make me a very competitive
candidate for this position. The key strengths that I possess for success in this
position include my eagerness to strive for continued excellence and provide
exceptional contributions for the company.
Please see my Curriculum Vitae for additional information on my experience.
I can be reached anytime via email at reimon_espejo@yahoo.com.ph or
r.espejo@inayahtpa.com or my cell phone no. 0527835584.
Thank you for your time and consideration. I look forward to speaking with you about
this employment opportunity.
Sincerely,
Rei Mon Ong Espejo

2.  REIMON O. ESPEJO
 Al Muteena, Dubai
 Mobile No: 052-7835584
 Email: reimon_espejo@yahoo.com.ph
 OBJECTIVE:
 To secure a highly competitive and challenging position that provides venues to
apply skills and knowledge and, to obtain training for personal growth to significantly
contribute to the company.
 EDUCATIONAL BACKGROUND
 Bachelor of Science in Nursing
 Year 2007
 Lorma College
 San Fernando La Union, Philippines
 Bachelor of Science in Architectural Drafting
 Year 2003
 Saint Louis College
 San Fernando La Union
 PROFESSIONAL WORK EXPERIENCE
 INAYAH TPA LLC
 Senior Medical Claims Processor/Assessor
 DUBAI, UAE
Aug-3-2014 – Present
 Responsible for all claims Pre-authorization process In-Patient / Out-Patient / PBM
on our department from receiving request via phone, Fax and emails to claim
assessment based on protocols and adjudicating claim as per individual policy.
 Answers calls and mails from physician offices, hospitals, pharmacies and patients
using exemplary customer service skills.

3.  Accurately enters required information (non-clinical and structured clinical data) into
computer database.
 Reviews structured clinical data matching it against specified medical terms and
diagnoses or procedure codes (without the need for interpretation) and follow
established procedures for authorizing request or referring request for further
review.
 Calls or reply via email or fax to providers with precertification numbers/code as
needed and file completed precertification requests as per established procedures.
 Maintains patient confidentiality as defined by the authorities and company
regulations.
 Maintains cooperative working relationships with departments and providers
 Actively supports departmental and corporate strategic plans and ensure
successful implementation.
 Accurately assess, cost contains, audit invoices and manage medical claims received
and to settle them in accordance to liability, including communicating all decisions to
the providers, effectively and accurately and to retain copies of correspondence
sent, on file.
 Enters claims data into system white interpreting coding and understandings medical
terminology in relation to diagnoses and procedure.
 Processes claim forms, adjudicates for allocation of deductibles, co-pays, Co-
insurance maximums and provider. Accessing information and translating data into
acceptable claims processing departments.
 ARAB HEALTH GULF SERVICES (NEXTCARE) Medical Claims Processor/Assessor
 DUBAI, UAE
 1 JULY 2008 – 1 JULY 2014
 To provide a direct billing medical claims handling service and to act as a
focal point for claim’s requiring medical knowledge in conjunction with
fellow Claims Assessors.
 Work efficiently and effectively to eliminate any chance of fraud and
abuse over a claim, and flag any suspicious cases to Team Senior/Claims
Manager as soon as possible and complete fraud process.
 Ensure that proper and complete instructions on claim eligibility are
provided on pre assessment sheet for proper and timely settlement of the
claim.
 To continually strive to improve and develop medical knowledge, highlight
issues related to Table of Benefits with suggestions for improving Policy
wordings and Claims Stance documents.
 To fully investigate all information that is received concerning claims and
to query any anomalies that may occur.
 To manage and develop the internal and external relationships which allow the
claims function to operate effectively and efficiently.

4.  To promote the best image for the company through the professional appearance
and behaviour and adhere to company standards and procedures. To maintain the
highest level of personal conduct.
 Encodes and coordinates information related to patient health care thru medical
claims/bills for payment or denial within contract agreement or guidelines/protocol
 Verifies and updates relevant data into computerized systems and calculates
manually any adjustments needed.
 Familiarity in using medical terminology, ICD-9 coding for Medical claims, and
working knowledge of other insurance benefit plans including coordination of
benefits.
 Validate and support the deductions and discounts performed with proper
documentation
 Ensure that medical ethics are respected at all time during processing of the claims
 PERSONAL INFORMATION
 Date of Birth: August 05, 1982
 Place of Birth: San Fernando La Union, Philippines
 Religion: Roman Catholic
 Spouse Name: LauriceAlipioEspejo
 Civil Status: Married
 Visa Status: Residence Visa