This document contains a summary of Ralph Michael D. Baligod's resume. It lists his objective, qualifications, professional background and education. For his professional background, it details his experience working as a Medical Authorization Executive, Medical Pre-Authorization Executive, Medical Claims Officer, Reimbursement Claims Processor, and Medical Claims Processor/Auditor between 2014-2008 for various companies in Dubai and the Philippines. It also lists his Bachelor of Science in Nursing degree from 2006.

1. Ralph Michael D. Baligod
 Flat no. 208 Al Hassawi Bldg.
Al Qassimia, Sharjah UAE
 056-3987830
arembi1803@gmail.com
Objective:
To find work that is both stimulating and rewarding to embark on a career that
would make use of my knowledge and skills to its fullest and shape up my
personality as a whole.
Qualification:
Strong, dynamic, aggressive and results-oriented. Establishes good
interpersonal relationship and possesses a strong drive to learn. Can solve
practical problems. Can interpret a variety of instructions furnished in written,
oral, diagram or schedule form. Proficient in MS Word, MS Excel, MS
PowerPoint and internet literate.
Professional Background:
Neuron LLC – DSOA JULY 2014 - PRESENT
Dubai Outsource Zone
Job Designation: Medical Authorization Executive –
Medical Customer Care (Helpline)
Work Description :
• Assist members with patience, discipline, & positive approach to identify
all queries and information needed.
• Ensure that all calls are handled within agreed KPIs in an effective
manner.
• Maintain professional and high quality call handling in order to serve
Neuron members in the best possible way.
• Maintain open communications with other Neuron department to resolve
any related member issues.
• Report any unresolved member issues to the Assistant manager and
supervisor in addition to making sure that these issues are logged in the
“Member Follow up shared customer care sheet” at the end of agent shift
to allow other team agents to follow up the case.
• Escalating complaints to concerned departments.
• Helping IP team to arrange second opinions for members.
• Processing written cases/PBM transactions in overlap shifts.

2. • Making daily scheduled random calls to members for feedback on
satisfaction with Neuron services.
Neuron LLC – DSOA JULY 2014 - PRESENT
Dubai Outsource Zone
Job Designation: Medical Pre-Authorization Executive –
Medical Service Department (Helpline)
Work Description :
• Assist the provider for all queries in Policy of the insured member,
Medical Preauthorization, eClaimLink and ePrescription.
• Answers Inbound Calls providing Medical Preauthorization, Customer
Service Assistance, Technical Support issues in EclaimLink/e-
Prescription
• Managed filing and tracking insurance claims and informed patients and
providers of their pre-approval or medical claims status
• Assess and manage the request of the health care providers and even
insured members on certain information that pertains to their pre-
approval status
• Interact with Providers to give and process information in response to
inquiries, concerns, and requests on insurance policies following the
Company guidelines and protocols
• Handling Complaints and Escalated Calls by ensuring a resolution is
achieved
• Medical claims processing
• Abides standard processes and procedures for each Policy
• Identify and escalate priority issues per policy holder request
• Accurately process and record request for pre-approvals received thru
calls, faxes and emails
• Organize ideas and communicate oral messages appropriate to listeners
and situations
• Up to date with system information, changes, and updates
• In communication with Providers by emails for preauthorization request
and issues/queries
• Review along with the Operations Manager, Supervisor, Team Leaders
Daily Call Reports to assess the adherence to KPI’s
• Updating self on the new groups, any amendments to the existing
policies, about the addition, renewal and removal of groups for the
insurance companies
• Updating self on the existing medical knowledge, new medical
advancements, new techniques and drugs
• Processing claim forms, adjudicate for provision of deductibles, co-pays,
co-insurance maximums and provider settlements

3. Mednet UAE FZ L.L.C MARCH 2013 – JUNE 2014
Dubai Internet City
Job Designation: Medical Claims Officer – E-claims / Direct Claims
Work Description:
 Process fast and efficient E-claims from the provider.
 Always check tariff and agreed discount for E-claims.
 Deductible and co-payments must be applied and checked.
 Ensure evaluated claims must be entered right code for denials.
 Finalizing number of invoices match to the given provider.
 Double check amounts and invoices before update and report
batches.
Nextcare Health Insurance Inc. SEPTEMBER 2011 - 2013
Business Avenue, Deira, UAE
Job Designation: Reimbursement Claims Processor
Work Description:
 Processes/audits reimbursement claims as per company policy.
 Checks the tariff list for the price for the designated policy holder.
 Print final statements for cheque preparation.
 Sends emails and calls companies regarding the status of the
reimbursement.
Nextcare Health Insurance Inc. SEPTEMBER 2008 - 2011
Business Avenue, Deira, UAE
Job Designation: Medical Claims Processor/Auditor
Work Description:
 Receives and collects physical claims from the provider after doctor
evaluation.
 Always check networks, tariffs and policies of the health care
providers.
 Processes medical files:
- E-claims
- International and Local Claims
- Diagnostic Procedures
- Pharmaceutical Medicines
 Enter Claims data into system while interpreting coding ICD-9 and 10
and applied appropriate deductible, co-payments and eliminates
standard exclusion as per policy agreements.

4.  Audits data to ensure no wrong entry of patient name, form number,
invoice number and also eliminate frauds and prepare detailed
reports of audit findings.
 Prepares and provides payment order to the service provider.
Seminars Attended
 ICD-9 and ICD-10 codes (14TH
MAY 2012)
Business Avenue 10th
floor section B
Deira, Dubai
 Code of Conduct Training (15th
June 2011)
Business Avenue 10th
floor section B
Deira, Dubai
Lazer Med Insurance Inc. May 2007 - June 2008
Unit 14, LLG Bldg.
Orambo, Pasig City, Philippines,
Job Designation: Medical Summarizer
Work Description:
 Analyzes patient’s document and gathering information of previous data.
 Accurately checks on patient’s medical history.
 Summarizes patient’s history from and until discharge.
 Prepares the invoice of patients for insurance purposes.
 Keeps track of medical records to ensure efficiency of work.
 Responsible for presenting complete documents to the provider.
Educational Background:
Bachelor of Science in Nursing 2002-2006
De Ocampo Memorial College
Ramon Magsaysay Blvd.,
Sta. Mesa, Manila, Philippines
Personal Information:
Birth date : August 16, 1983
Gender : Male
Status : Married
Nationality : Filipino
Visa Status : Company Visa
Languages Spoken : English and Filipino
Driver License : UAE driver license (YES)

5. References:
Available upon request

6. References:
Available upon request