Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Mary Nguyen

Brisbane,QLD

Summary

I have had 8 years experience within the Health Insurance sector and I am completing a qualification in Clinical Coding.

I served as a Senior Claims Specialist for Catholic Church Insurance for 4 years. I specialised in the end to end management of Student Accident Claims.

This role includes the ongoing management of complex claims and is not limited to qualifying claims, reviewing reports, verifying insurance coverage and processing settlements.

I have deep knowledge of the health insurance claims industry. Solid abilities in developing objectives and strategies to settle and process claims. Excellent skills compiling, coding, categorizing and auditing information to process claims. I have great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
My strong work ethic and eagerness to learn will ensure success in a new work place.

Overview

12
12
years of professional experience

Work History

Outbound Retention Specialist

BUPA Health Insurance
01.2024 - Current
  • Proactive customer focused approach, to reduce customer discontinuance
  • Strong written and verbal communication skills for effective objection handling and customer resolution
  • Resilient and adaptable towards a dynamic and ever changing environment
  • Applied advanced and comprehensive Private Health Insurance knowledge to cross sell and upsell company products
  • Claims and needs analysis to identify upsell and resell of Health Insurance products
  • Managing escalations regarding claim denials and policy coverage
  • Strict Adherence to company compliance and procedures
  • Exceeding KPIs as well as NCR/NPS targets set by management

Senior Personal Accident Claims Assessor

Catholic Church Insurance
07.2019 - 12.2023
  • Managed a caseload of complex claims, ensuring timely settlements and maintaining client satisfaction.
  • Assisted claimants throughout entire submission process. Providing guidance regarding documentation requirements needed to substantiate requests.
  • Discussing expectations concerning how long investigations might take before final decisions made about whether to approve deny payouts
  • Reviewing medical documents and invoices to process claim benefits
  • Liaising with allied health staff regarding treatment plans and claims coverage for treatment
  • Utilized specialized software to process incoming claims, enter data and generate reports.
  • Reviewed policy documents thoroughly before initiating coverage assessments so as not only identify gaps but also accurately interpret terms conditions applicable each situation faced when handling specific incidents reported insured individuals businesses seeking assistance under their respective insurance plans offered managed our organization.
  • Managed claims escalations relating to public liability, AHPRA and third party escalations
  • Auditing claims to check for breaches in policy/coverage as well as claims leakage
  • Enhanced team productivity by providing ongoing training to junior claims specialists on best practices and industry trends.
  • Maintained compliance with regulatory requirements through diligent documentation of all claim activities.
  • Conducted thorough investigations for accurate liability determination, leading to fair claim resolutions.
  • Mitigated potential losses by identifying fraudulent claims and coordinating with the fraud investigation unit.
  • Facilitated cross-functional collaboration between departments for streamlined case management and information sharing.
  • Streamlined claims processing by implementing efficient workflow procedures and prioritizing high-impact cases.
  • Established trust among clients by consistently demonstrating empathy and understanding throughout the entire claims assessment process.
  • Effectively managed high-pressure situations during peak periods of claims activity while maintaining professional demeanour and efficient performance levels.
  • Reduced claim resolution time by effectively collaborating with internal teams, clients, and third-party professionals.

Claims Assessor

BUPA Health Insurance
06.2018 - 06.2019
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Assessment of claims and eligibility under claimant's level of cover
  • Reviewing medical documents and invoices to process claim benefits
  • Managed high volume of claims, prioritizing tasks to meet deadlines
  • Utilized specialized software to process incoming claims, enter data and generate reports.
  • Auditing claims to reduce claim leakage and fraud
  • Identified fraudulent claims through thorough investigation and documentation of findings.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Identified and reported potential fraud or abuse related to claims to protect system's integrity.
  • Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
  • Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
  • Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
  • Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
  • Provided support during internal and external audits, ensuring accurate representation of the company''s claim history.
  • Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
  • Assisted in updating company guidelines for consistent application of policies across all claims processed.
  • Participated in various professional development opportunities to stay current on industry regulations, best practices, and emerging technologies relevant to claim processing activities.


Outbound Retention Specialist

BUPA Health Insurance Australia
01.2016 - 07.2018
  • Proactive customer focused approach, to reduce customer discontinuance
  • Strong written and verbal communication skills for effective objection handling and customer resolution
  • Resilient and adaptable towards a dynamic and ever changing environment
  • Applied advanced and comprehensive Private Health Insurance knowledge to cross sell and upsell company products
  • Claims and needs analysis to identify upsell and resell of Health Insurance products
  • Strict Adherence to company compliance and procedures
  • Exceeding KPIs as well as NCR/NPS targets set by management

Business Account Manager

Telstra Business Centre
01.2013 - 12.2015
  • Maintain strong business relationships with existing business customers
  • Build relationships and rapport with customers to increase repeat business rate
  • Identifying the customer needs by using effective questioning and active listening
  • Tailoring solutions that will be most beneficial for their business
  • Up selling and cross selling business products
  • Coordinate between different departments and customers to resolve problems
  • Generating leads for Business Development Managers
  • Reaching KPI and sales targets set by management
  • Maintain knowledge of current sales and promotions, business solutions
  • Using and navigating multiple computer systems effectively and promptly
  • Making outbound calls as well as taking inbound calls from existing and new customers
  • Communicate articulately with customers during face to face appointments, via phone or email

Education

Diploma - Clinical Coding

HIMAA
QLD
12.2025

Bachelor of Speech Pathology -

The University of Queensland

High School Diploma -

Forest Lake State High School

Skills

  • Strong verbal and written skills
  • High attention to detail, data entry, accuracy
    and adherence to procedures
  • Ability to multi task across multiple systems and business channels
  • Customer centric approach to allow for a positive
    outcome
  • Competent in Microsoft Office
  • Accurate and detailed 90 WPM typing speed
  • Resilient and adaptable towards and dynamic environment
  • Effectively communicates with other departments
    within the business

Accomplishments

BUPA Global Awards Finalist - Top Retention Consultant AU & NZ 2018,
BUPA Retention Consultant Q1 QLD and VIC for 2017 BUPA Top Retention Consultant QLD & VIC 2016

Telstra Business Centre Top Account Manager 2015

Timeline

Outbound Retention Specialist

BUPA Health Insurance
01.2024 - Current

Senior Personal Accident Claims Assessor

Catholic Church Insurance
07.2019 - 12.2023

Claims Assessor

BUPA Health Insurance
06.2018 - 06.2019

Outbound Retention Specialist

BUPA Health Insurance Australia
01.2016 - 07.2018

Business Account Manager

Telstra Business Centre
01.2013 - 12.2015

Diploma - Clinical Coding

HIMAA

Bachelor of Speech Pathology -

The University of Queensland

High School Diploma -

Forest Lake State High School

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