Kimberly Bongalon

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.

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