Summary
Overview
Work History
Education
Skills
Personal Information
Mva Skills
References
Timeline
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RAQUEL RACMAN MORGA

RAQUEL RACMAN MORGA

BINANGONAN

Summary

Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.

Overview

10
10
years of professional experience

Work History

Claims Specialist | VA

Audiology Success LLC
North Carolina
01.2025 - 05.2025
  • Assisted with filing appeals on denied claims with insurance companies.
  • Identified trends in rejected claims that could indicate system errors or fraudulent activity.
  • Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
  • Collaborated with other departments within the organization to resolve issues related to claims processing.

Claims Analyst | Remote

Med-Metrix Phil.
Pasig
11.2022 - 01.2025
  • Prepared detailed reports on claim status, payment history, and other relevant information.
  • Researched applicable laws and regulations related to insurance policies and procedures.
  • Conducted investigations to gather evidence in support of claims resolution.
  • Managed escalated cases involving high-value claims or multiple parties involved.
  • Maintained accurate records of all claim activities in accordance with company policies.

Intake Coordinator

NTT Data Services
Quezon
05.2021 - 11.2022
  • Provided customer service support by responding promptly to provider inquiries regarding authorization status or policy information.
  • Processed high volume of requests within established turnaround times while maintaining quality standards.
  • Participated in training sessions as needed to stay current on changes in healthcare industry regulations.

Customer Service Representative

Hinduja Global Services
Pasig
05.2015 - 05.2021
  • Provided accurate information about products and services to customers.
  • Resolved customer complaints promptly and efficiently.
  • Answered customer inquiries and provided accurate information regarding products and services.
  • Maintained a high level of professionalism when dealing with difficult customers.
  • Provided excellent customer service to resolve customer complaints in a timely manner.

Education

Bachelor of Science - Computer Science

Manuel L Quezon University
Manuel L Quezon University
01.2002

Skills

  • Time management and prioritization
  • Attention to detail
  • Critical thinking skills
  • Adaptability
  • Multitasking
  • HIPAA Certified
  • EMR/EHR
  • Epic
  • Blueprint
  • CounselEar
  • CMD
  • Ring Central

Personal Information

Title: CERTIFIED MEDICAL VIRTUAL ASSISTANT

Mva Skills

  • Medical Billing
  • Claims Denial Management
  • HIPAA Compliance
  • Familiar with EHR/EMR systems

References

References available upon request.

Timeline

Claims Specialist | VA

Audiology Success LLC
01.2025 - 05.2025

Claims Analyst | Remote

Med-Metrix Phil.
11.2022 - 01.2025

Intake Coordinator

NTT Data Services
05.2021 - 11.2022

Customer Service Representative

Hinduja Global Services
05.2015 - 05.2021

Bachelor of Science - Computer Science

Manuel L Quezon University

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RAQUEL RACMAN MORGA