Hi, I’m
Neleene Delos Santos
Manager | Health Insurance Expert | Data Analytics | Process Improvement
Quezon City
Summary
Results-driven healthcare operations professional with 20+ years of experience in claims adjudication, medical billing, and ICD-10 coding. Expert in data analytics, compliance audits, and process improvement, serving as BUCC for ISO readiness and operational efficiency.
Overview
24
years of professional experience
Work History
Maxicare Healthcare Corporation
Service Delivery Manager - Inpatient Services
01.2019 - 01.2025
Job overview
- Lead inpatient service delivery from admission to discharge across nationwide providers.
- Ensure seamless discharge coordination with providers, members, and internal teams.
- Prepare performance reports and monitor service quality and fraud detection.
- Implement enhanced E2E discharge processes for personalized member support.
Maxicare Healthcare Corporation
Claims Manager / Assistant Manager
01.2013 - 01.2019
Job overview
- Oversaw end-to-end claims processing for major hospitals and providers.
- Conducted performance tracking, data validation, and audit readiness reports.
- Ensured compliance with health insurance policies, SLA adherence, and billing accuracy.
- Led root cause analysis and corrective action planning for high-value claim discrepancies.
Maxicare Healthcare Corporation
Claims Supervisor
01.2009 - 01.2013
Job overview
- Supervised in-house and outsourced claims operations for accuracy and compliance.
- Monitored team performance and process efficiency.
- Supported audits, reporting, and staff development.
Maxicare Healthcare Corporation - St Luke's Medical Center
Claims Analyst
01.2002 - 01.2009
Job overview
- Processed inpatient and outpatient claims with accuracy and compliance.
- Verified billing, benefits, and provider documentation.
- Resolved claim issues through provider coordination and data validation.
- Supported audits and process improvements to reduce turnaround time.
Aetna Healthcare Corporation
Claims Analyst
01.2000 - 01.2002
Job overview
- Reviewed and adjudicated medical claims per company policies.
- Ensured accurate, timely processing and provider coordination.
- Maintained compliance with healthcare and billing standards.
San Miguel District Hospital
Physical Therapy Assistant
01.1998 - 01.2000
Job overview
- Assisted in implementing patient rehabilitation programs under licensed physical therapists.
- Maintained treatment records and coordinated with medical teams for patient care plans.
Education
Excel Helpline
Master of Data Analytics
09.2025
Emilio Aguinaldo College
Bachelor of Science from Physical Therapy
04.1997
Skills
Healthcare service management
Claims Processing(Inpatient/Outpatient)
Medical Billing & ICD-10 Coding
Data Analytics & Reporting
Fraud Detection & Risk Control
Compliance & ISO Audit (BUCC)
Quality Assurance & Process Improvement
Provider & Member Relations
Discharge Coordination
Workflow Optimization
Customer Service Excellence
References
- Analyn, Astorga, Assistant Vice President, analyn@phillife.com.ph, 095627448373, Phillife Philippines
- Karen, Damian, Service Delivery Manager, karen.damian@optum.com, 09053549612, Optum Global
Trainings
- ISO 22301 Business Continuity Management System Training-TUV Rheinland March 17-18, 2022
- Project Management Fundamentals Phoenix One Knowledge Solutions Inc. (November 16-19, 2021)
- Google Workspace- Collab January 21, 2021
- Lean Process Improvement- Managing Quality Records & Documented Information Training January 16, 2019
- Training course on ICD 10 for coders Apex Global July 31-August 2, 2019
- Philippine Medical Records Association December 6-10, 2010
Timeline
Service Delivery Manager - Inpatient Services
Maxicare Healthcare Corporation
01.2019 - 01.2025
Claims Manager / Assistant Manager
Maxicare Healthcare Corporation
01.2013 - 01.2019
Claims Supervisor
Maxicare Healthcare Corporation
01.2009 - 01.2013
Claims Analyst
Maxicare Healthcare Corporation - St Luke's Medical Center
01.2002 - 01.2009
Claims Analyst
Aetna Healthcare Corporation
01.2000 - 01.2002
Physical Therapy Assistant
San Miguel District Hospital
01.1998 - 01.2000
Emilio Aguinaldo College
Bachelor of Science from Physical Therapy
Excel Helpline
Master of Data Analytics