Cyril de Jesus Tolado: Senior Executive - HR & Insurance Division

Cyril De Jesus Tolado
Mobile no. 050 4240629

Email Ad: [email protected]
Professional Experience
Senior Executive – HR & Insurance Division
November 2015 – Present
Damas Jewellery LLC
JLT, Dubai
- To liase with Insurance Company / Broker regarding eligibility, premium payments,

approvals and reconciliations
- Reviewing and analyzing insurance premiums and recommends appropriate internal
distribution amount funding sources
- Ensuring coverage of medical insurance policy of employees of Damas (UAE and GCC)
- Maintain close and constant interaction with Insurance Company to obtain up to date
market information and information on new regulations of insurance in Dubai policies
and coverage
- Monitors all reimbursement claims until settlement is complete and timely distribution
of settlement cheques to the employees.
- Responsible and prepares documentations for ensuring addition of employees under
the medical insurance policy of Damas as per Dubai Health Authority regulations
- Assisting staff to process pre-approvals of medical treatment and medical claim
reimbursement
- Train and educate the staff in medical insurance related matters.
- To ensure all of the involved parties provide correct information, and that the
information is disseminated in a timely manner.
- Updating HR net according to the requirements of HR and Insurance Dept.
- Process employee requests / certificates (NOC, Salary Certificates, Work and Experience
Certificates, Contract Change request, Confirmation Letters, Insurance related
certificates & Letters)
- Assist in On-boarding process of new joiners
- Responses to employee verifications from difference banks, institution and companies.
- Maintaining absolute confidentiality of documents and information contained in HR
documents.
- Perform any other duties assigned by HR Director
Senior Medical Claims Officer
March 2009 – October 2015
Prime Insurance Brokers
Abu Dhabi UAE
- Reviews and examine medical claim documents submitted by the respectable clients for
Medical Claim Reimbursement
- Effective client servicing by providing utmost assistance to clients
-Coordinate with Doctors/Providers on medical authorization procedure requests if they are not
acceptable and recommend appropriate alternate approaches.
-Ensures timely processing and evaluates the medical settlement cheques for claim
reimbursements.
-Follow all relevant departmental policies, processes, standard operating procedures and
instructions so that claim processing is carried out in a controlled and consistent manner.
-Coordinates with Third Party Administrator/Insurance companies for all Medical Insurance
inquiries and concerns
-Deals with customers, insurance coordinators, doctors and pharmacist for the approval of
treatment inside and outside UAE.
-Maintaining accurate and timely information in each patient’s medical records
-Liaise with patients regarding their eligibility and entitlements
-Handles and examines claim documents for workmen’s compensation claims and group life
insurance claim settlement.
-Analyze and evaluate insurance policy coverage, terms, conditions, and exclusions applicable to
incidents and determine the implications on recovery.
-Liaising among different departments claims related issues e.g. administration, accounts etc.
-Follows adjudication policies and procedures to ensure proper payment of claims.
-Assessing International & Local medical Group or Individual insurance claims as per the policy
terms and condition.
-Administration and formulation of database of eligible clients
Medical Insurance / HR Employee Services Coordinator

December 2007 – December 2008
Dubai Properties Group
Media City, Dubai - UAE
-Coordinates with Third Party Administrator for all Medical Insurance inquiries and concerns
-Assists in induction processes of newly joined employees as well as educating them with
medical insurance policy.
-Responsible for issuance of insurance cards for all employees
-Reviews and examine claim documents submitted by the employees for Medical
Reimbursement
-Ensures timely processing and assess the settlement cheques for reimbursements
-Gathers all the information needed for the issuance of new medical insurance card.
-Updates Oracle Database for payroll processing.
-Handles issuance of employment and/or salary certificate and bank loan letters for employees.
-Maintains records, files, reports and other written date pertinent to the assignment and
prepares reports based upon these records and information as required
-Provides current health insurance booklet and application
-Provide assistance on pre-employment medical processing, referrals, approvals
-Medical and hospitalization assistance.
-Conducts special meetings of employee and training as necessary to ensure that each employee
is kept current and informed on changes in medical insurance policy, procedure, rules and
regulations.
Senior Medical Insurance Coordinator

April 2007 – November 2007
Arabia Insurance
Dubai - UAE
-Provides resolution to insurance related concerns, outlines and executes requests as per
needed by the client / customer
-Performs administrative related jobs
-Managed filing and tracking insurance claims and informed patients of their claims status.
-Prepares insurance forms and associated correspondences.
-Perform other duties as assigned by Supervisor.
-Demonstrates attention to detail in specifications development and documentation and record
keeping.
-Preparation of portfolio reports (Quarterly, Half-yearly and yearly).
-Identify and resolve patient billing complaints
Medical Call Center Representative

July 2006 – March 2007
Mednet UAE, L.C.C.
Dubai UAE
-Ensures outbound and inbound calls

-Collaborates with members of the clinical care team to improve access, reduce backlog of calls
and claims and minimize delays along the value stream of the patient encounter
-Reviews medical request/ hospital reports of members submitted for claim reimbursement
-Deals with customers, insurance coordinators, doctors and pharmacist for the approval of
treatment inside and outside UAE.
-Provides excellent customer service to improve relationship with customers.
-Implement business retention programs and plans for the clients.
-Works closely with leadership and the clinical team to continuously improve, simplify and
mistake-proof clinic processes to enhance the patients' experience.
-Responsible for and ensures compliance with requirements and act as liaison between the
customer and Insurance companies
-Providing assessment using the International Classification of Diseases (ICD 9 and ICD 10) and
Current Procedural Terminology codes
-Independent and timely processing of claims in accordance with client requirements, member
plan benefits, and applicable network fee schedules with minimal assistance
-Aids members and healthcare providers regarding all issues related to their health care policies
through our 24-hour helpline
Business Processor Specialist – Medical/Dental Claims
May 2005 - June 2006
American General Insurance Co. (AIG)
Alabang - Philippines
-Operates Medical Claims Processor program

-Provides direction to the business development specialist in sourcing out and processing of
applications.
-Provide financial and accounting process outsourcing services and solutions to commercial
customers
-Responsible in processing dental and medical claims
-Work closely with internal customers to proactively identify issues impacting financials and
provide decision support to management, streamline Month End Close processes,
participate in critical projects, and ensure service delivery.
-Supports various business units with their day-to-day target requirements, including but
not limited to proposal generation and quota
Senior Claims Processor

December 2003 – January 2005
NICPHIL Insurance Company
Makati City - Philippines
-Provides resolution to insurance related concerns, outlines and executes requests as per need
by the client / customer
-Prepares written correspondence, chat sessions, fax or written correspondence related to
customer inquiries and/or sales.
-Process evaluation & documents related to insurance claims
-Responsible for processing personal accident
Call Center Specialist

June 2002 – October 2003
DIGITEL Inc.
Makati City – Philippines
-Closely interact with clients and customers to provide superior customer service, sales and
support via phone
-Review new accounts and analyze customer transaction
-Resolve all complaints and answer all inquiries effectively.
-Provides written feedback relative to consumers’ queries or complaints
-Handles negotiation and provide assistance to subordinates in dealing with consumers.
-Communicates relevant patient information appropriate insurance company as needed.
Claims Assistant
October 2001 – June 2002
AETNA Healthcare Insurance Co.
Makati - Philippines
-Handles auditing and encoding payables of members coming from different listed hospitals
-Assist all Insurance related claims
-Handles Liquidation of claims
-Medical coder
-Assist in resolving of any complaints from insured
-Updates and monitors customer concerns via phone
-Completes any additional job duties as assigned.
-Demonstrates outstanding focus on the patient as our primary customer
Education
Bachelor of Science in Physical Therapy

1996-2001
Manila Central University
Caloocan City, Philippines
Personal Details
Date of Birth: November 28 1978

Nationality: Filipino
Status: Single
Languages: Tagalog and English
References
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Cyril De Jesus Tolado

Mobile no. 050 4240629

- To liase with Insurance Company / Broker regarding eligibility, premium payments,

Medical Insurance / HR Employee Services Coordinator

Senior Medical Insurance Coordinator

Medical Call Center Representative

-Ensures outbound and inbound calls

-Operates Medical Claims Processor program

Senior Claims Processor

Call Center Specialist

Bachelor of Science in Physical Therapy

Date of Birth: November 28 1978

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