WILLIAM JR ETRATA
AUCKLAND,AUK
Summary
Experienced Claims Officer with comprehensive background in handling, investigating and processing insurance claims. Strengths include strong investigative skills, keen ability to assess claim validity, and proficiency in negotiating settlements. Previous work has consistently demonstrated successful resolution of complex claims, contributing to positive customer experiences and company reputation.
Organized and knowledgeable Registered Nurse experienced in treating and caring for patients. Successful in providing fast and accurate assessments and working calmly under pressure. Recognized for collaborating well with doctors to maintain top-notch healthcare practices.
Overview
1
1
Certification
29
29
years of post-secondary education
20
20
years of professional experience
Work History
Medical Claims Officer- Team Leader
Total Care Saudi
Al-Khobar
01.2010 - 10.2026
- Managed reimbursement claims processing unit, optimizing workflow to enhance claim resolution speed. – Total Care
- Reviewed insurance reimbursement claims, ensuring compliance with company practices and accurate payments.
- Determines if the costs are reasonable given the diagnosis, based on available information about expected treatments & average hospital stays for various ailments.
- Delegates workload across the team to ensure that the desired TAT is achieved.
- Identified and reported suspicious claims to Claims Manager, contributing to fraud prevention efforts.
- Enters claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Answers client queries & exchanges information with customers using the telephone and electronic mail (e-mail).
College Instructor
Urdaneta City University
Urdaneta City, Pangasinan
11.2008 - 06.2009
- Explains the topics for students to understand what is being discussed.
- Provides students with the course outline of the subject.
- Monitored student performance through examinations and assessments to evaluate understanding.
- Uses modern information and communication techniques in the classroom.
- Recorded student attendance to monitor participation in classes. to ensure student participation and engagement.
- Documented student performance data to track progress.
- Provided guidance to students facing conflicts with peers or staff to facilitate resolution.
- Prepares and submits grading sheets at the end of the semester.
- Oversaw students during nursing skills practice to ensure safety and compliance. in the performance of nursing skills.
Clinical Nurse Instructor
Lyceum Northern Luzon
03.2007 - 03.2009
- Orients students to the policies to be observed in a particular hospital/institution.
- Reminds students of the requirements and responsibilities for the whole duty.
- Monitored student performance in clinical practice to ensure competency and readiness.
- Allows and supervises students to perform nursing skills in actual clinical settings.
- Discusses topics related to medical-surgical cases that have been observed in the clinical area.
- Monitored and documented attendance to ensure student accountability.
- Recorded attendance and tardiness of students during clinical sessions.
- Prepared and submitted comprehensive grading sheets to clinical coordinator for accurate assessment.
- Ensured safety of students in clinical area by enforcing protocols and providing guidance.
Intensive Care Nurse
Urdaneta Sacred Heart Hospital
09.2006 - 08.2007
- Assists in the admission of patients in the unit.
- Executed cardiopulmonary resuscitation during emergencies.
- Monitored vital signs and measured fluid intake and output to ensure patient stability.
- Executed medical orders from physician to ensure patient care.
- Observes medical asepsis, signs and symptoms, institutes remedial actions when appropriate, and reports observations to the physician.
- Charts accurately medications and treatment given.
- Executed physician's treatment plans promptly and accurately.
- Prepares the necessary equipment/supplies for the patient's use.
- Executed cardiopulmonary resuscitation during emergencies.
Education
Master of Arts - EDUCATIONAL MANAGEMENT
PANPACIFIC UNIVERSITY NORTH PHILIPPINES
Urdaneta 09.2023 - 10.2025
BACHELOR OF SCIENCE - SECONDARY EDUCATION
URDANETA CITY UNIVERSITY (formerly City Colleges of Urdaneta)
San Vicente West, Urdaneta CityBACHELOR OF SCIENCE - NURSING
URDANETA CITY UNIVERSITY (formerly City Colleges of Urdaneta)
San Vicente West, Urdaneta City 11.2002 - 03.2026
Special Science Class
URDANETA NATIONAL HIGH SCHOOL
San Vicente West, Urdaneta City 06.1997 - 03.2001
Skills
- Claims management
- Reimbursement analysis
- Insurance compliance
- Insurance coverage verification
- Insurance calculation
- Customer service
- Patient rapport
- Claims system entry
- Document review
- Attention to detail
- Teamwork
- Multitasking capacity
- Task prioritization
- Workflow coordination
- TAT management
- Team leadership
- Teamwork and collaboration
- Verbal and written communication
- Professionalism
- Numeracy skills
- Medical terminology
- Medical coding review
Skills
• Claims management
• Reimbursement analysis
• Insurance compliance
• Insurance coverage verification
• Insurance calculation
• Customer service
• Patient rapport
• Claims system entry
• Document review
• Attention to detail
• Teamwork
• Multitasking capacity
• Task prioritization
• Workflow coordination
• TAT management
• Team leadership
• Teamwork and collaboration
• Verbal and written communication
• Professionalism
• Numeracy skills
• Medical terminology
• Medical coding review
Certification
- Registered Nurse - Philippines' Professional Regulation Commission
- Insurance Foundations Professional Exam - Saudi Arabian Monetary Academy
- Licensed Professional Teacher - Philippine's Professional Regulation Commission (PRC)
Timeline
Master of Arts - EDUCATIONAL MANAGEMENT
PANPACIFIC UNIVERSITY NORTH PHILIPPINES
09.2023 - 10.2025
Medical Claims Officer- Team Leader
Total Care Saudi
01.2010 - 10.2026
College Instructor
Urdaneta City University
11.2008 - 06.2009
Clinical Nurse Instructor
Lyceum Northern Luzon
03.2007 - 03.2009
Intensive Care Nurse
Urdaneta Sacred Heart Hospital
09.2006 - 08.2007
BACHELOR OF SCIENCE - NURSING
URDANETA CITY UNIVERSITY (formerly City Colleges of Urdaneta)
11.2002 - 03.2026
Special Science Class
URDANETA NATIONAL HIGH SCHOOL
06.1997 - 03.2001
BACHELOR OF SCIENCE - SECONDARY EDUCATION
URDANETA CITY UNIVERSITY (formerly City Colleges of Urdaneta)