Kimberly Bongalon

Motivated and adaptable professional with 10+ years of experience in healthcare insurance, claims operations, administration, documentation, quality assurance, customer service, and team leadership. Seeking a challenging opportunity where I can apply strong organizational, communication, analytical, and problem-solving skills, contribute to operational excellence, and continue developing professionally in a dynamic organization. Willing to learn new systems, take on new responsibilities, and work effectively independently or as part of a team.

Senior Claims Analyst – Specialist II - Reliance Corp. - Mandaluyong City

(2023-01)

• Lead and oversee a high-performing claims team, promoting accountability, operational excellence, and compliance with established standards.
• Conduct team meetings, daily/weekly alignment sessions, and operational briefings to communicate updates, expectations, priorities, and process changes.
• Coach team members through one-on-one and group sessions, identify skill gaps, and facilitate orientation, retraining, and process-enhancement activities.
• Review, verify, and manage high-volume medical insurance documentation while maintaining accuracy and compliance.
• Conduct quality assurance audits, identify processing discrepancies and operational risks, and recommend corrective actions.
• Monitor productivity and quality through tracking dashboards and prepare information for management reporting.
• Coordinate with internal and external stakeholders to complete verifications and resolve workflow or claims-related concerns.
• Communicate professionally through Microsoft Teams, email, and inbound calls to support timely issue resolution.
• Contribute to continuous improvement by identifying process gaps and recommending practical improvements.

Administrative Aide - Local Government Unit of Mabini - Mabini, Pangasinan

(2022-07 - 2022-12)

• Welcomed and assisted visitors and constituents in a professional and courteous manner.
• Identified concerns and directed or endorsed requests to the appropriate action officers.
• Provided administrative assistance, documentation support, and customer service for daily office operations.
• Handled multiple requests efficiently while maintaining professionalism in a public-service environment.

Medical Claims Processor - Medicard Philippines, Inc. - Makati City

(2015-01 - 2022-01)

• Processed medical and dental claims accurately and within established turnaround-time and quality standards.
• Reviewed medical codes, supporting documents, claim information, eligibility, and applicable policies and procedures.
• Handled complex and specialty claims and determined appropriate return, denial, or payment actions based on guidelines.
• Coordinated with internal and external departments to resolve edits, deferrals, and claim-related concerns.
• Maintained accurate patient, provider, health insurance, and claim records; investigated processing issues and corrected errors through approved procedures.
• Responded to customer inquiries and complaints through online and telephone support channels.
• Prepared reports, letters, forms, and organized electronic and physical records for management and operational requirements.
• Consistently supported productivity, accuracy, quality, compliance, and service standards.

Secondary Science Teacher - Western Pangasinan Lyceum - Bani, Pangasinan

(2013-06 - 2014-05)

• Developed lesson plans and learning activities aligned with education standards.
• Delivered instruction through lectures, discussions, demonstrations, activities, and independent practice.
• Adapted lessons to different learning abilities and maintained accurate classroom records.
• Communicated with parents regarding student progress, behavior, and academic development.

Food & Beverage Attendant - Food & Beverage Operations - Philippines

(2012-06 - 2013-05)

• Provided courteous customer service and supported day-to-day food and beverage operations in a fast-paced environment.
• Assisted with customer requests, service coordination, and maintaining organized work areas.

Bachelor of Secondary Education - Physical Science - Pangasinan State University – Lingayen Campus (2008 - 2012)

Caregiving NC II / Healthcare NC II - Golden West Colleges (2020-01 - 2020-02)

Secondary Education - Riverview High School (2004 - 2008)