KRISTINE SARA BUNGGAY
Sharjah
Summary
Results-driven Medical Claims Analyst with over 16 years of experience in analyzing and evaluating medical insurance claims. Expertise in verifying patient information, reviewing medical records, and accurately coding claims. Proven ability to identify and resolve complex claims issues, ensuring timely processing and successful submissions. Holds a Bachelor’s degree in nursing and possesses strong analytical and communication skills, enhancing claims management and compliance adherence.
Overview
20
20
years of professional experience
Work History
Senior Claims Analyst
Prime Healthcare Group
11.2011 - 03.2025
- Specialized in examining and processing medical claims ensuring compliance with insurance policies and regulations to all Major Insurance Companies like Mednet, Daman, AXA/GIG, Nextcare, Sukoon Insurance, NAS Administration Services, Metlife, Neuron etc.
- Possessed in-depth knowledge of CPT, ICD-10, and HCPCS codes for accurate claims submission.
- Investigate and resolve discrepancies in claims, ensuring timely processing.
- Managed and resolved claim rejections, collaborating with internal teams to rectify issues promptly.
- Utilize electronic claims processing systems to submit and track claims efficiently.
- Conduct audits of claims to identify discrepancies and implement corrective actions.
- Collaborate across all Prime Branches to obtain necessary information for claim submissions.
- Internal Coordination and Communication with all branches of group and conducting training sessions on claims processing procedures, enhancing team efficiency and performance.
- Attends meeting and trainings with the Insurance companies/ TPA’s/ DHA.
- Coordinates with Network, IT, Accounts and other departments as required.
Data Entry Operator / Quality Checker / HR Assistant
German Health Consult
Dubai Healthcare City
09.2008 - 09.2011
- Quality checking of claims as per agreed percentage of members for verification of data entered.
- Assessing claims as per agreed client’s policy from Fatal, Critical and Ok claims for data entry.
- Entering raw data consisting of numbers, text from handwritten or important details in claim form to the data entry GUI system.
- Validating claims entered as per client’s policy and reassurance of claims entered prior to completing the claim.
- Coordinating with the team about proper arrangement of claim forms, invoice and other supporting documents.
- Trained in Human Resource Management.
Nurse
Angeles Medical Center
04.2005 - 10.2005
- Maintains patient’s file.
- ICU, Emergency and First Aid management.
- Assisting in procedures like, Minor and major dressing, wound care, nebulization.
- Administration of medications as prescribed, vital signs monitoring and recording.
- Resuscitation during cardiac and respiratory arrest.
- Patient and family counselling i.e. importance of regular follow ups.
- Responsible for total patient care and safety.
Education
Bachelor of Science - Licensed And Registered Nurse
Perpetual Help College
Manila01.2004
Bachelor of Science - Nursing
University of the East Ramon Magsaysay Medical Ctr
Skills
- Analytical skills
- Problem-solving abilities
- Communication skills
- Insurance policy knowledge
- Regulatory compliance expertise
- Claims management proficiency
- Microsoft Office Suite expertise
- Attention to detail
- Deadline-oriented work ethic
- ICD-10-CM coding proficiency
- CPT coding expertise
- Insurance process knowledge
Trainings And Seminars
- CPC(ICD 10) Certification
- Basic Life Support
- First Aid Training
- Eclaims Dubai Provider Training
- Insurance Company Portal Training i.e. Mednet Connect, Daman, Thiqa Top-up, Nextcare SAADA etc.
References
available upon request
Disclaimer
I hereby assent that the above-mentioned details and information are true and correct and with my full knowledge.
Skills And Software
- ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) and CPT coding (Current Procedural Terminology)
- Vast knowledge of insurance processes, especially in OP, ER, IP, diagnostic cases, and pharmacy claims
- Eclaims, Riayati, Paper Claims, Top-up Submissions
- Knowledge on Major Insurance Companies and TPA’s–Daman, Nextcare, Mednet, AXA, Neuron, Oman, NAS
- DHPO – Dubai Health Post Office and Riyati
- HIS – Healthcare Information System
- LIS – Laboratory Information System
- RADSpa – Radiology Intelligence with an Integrated Image Management
- EMR - Electronic Medical Records
- DMS - Document Management System
- Yasasii system – Comprehensive Healthcare Information System (HIS)
- Gui system – Graphical User Interface system
- Excellent in MS Office particularly in Excel, Word & Power Point
Personal Information
- Citizenship: Filipino
- Date of Birth: 12/23/83
- Marital Status: Married
- Visa Status: Husband's visa
Timeline
Senior Claims Analyst
Prime Healthcare Group
11.2011 - 03.2025
Data Entry Operator / Quality Checker / HR Assistant
German Health Consult
09.2008 - 09.2011
Nurse
Angeles Medical Center
04.2005 - 10.2005
Bachelor of Science - Licensed And Registered Nurse
Perpetual Help College
Bachelor of Science - Nursing
University of the East Ramon Magsaysay Medical Ctr
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