Rolando Peñaranda Jr
Bacoor Cavite,Philippines
Summary
Analytical Medical Claims Analyst skilled in claims processing and resolution. Ensures compliance by verifying member coverage and eligibility. Addresses underpayment and denial issues to improve claims efficiency. Combines experience in customer service and medical claims analysis, demonstrating effective problem-solving and communication to support team objectives.
Overview
8
8
years of professional experience
Work History
Medical Claims Analyst
Med-Metrix
Ortigas, Philippines
08.2025 - Current
- Reviewed remittance advice and analysed claim processing and payment patterns
- Verifying member's coverage and eligibility
- Well known in insurance portal utelization
- Resolved underpayment and denial issues to ensure accurate reimbursements
- Established expertise in re-billing, submitting corrected claims, and managing reconsiderations and medical records
Front Desk Receptionist
Tanba-Chigui Ban&CO Inc.
Johor Bahru, Malaysia
03.2023 - 06.2025
- Coordinated booking reservations via phone, email, and in-person interactions, ensuring accuracy and enhancing guest satisfaction.
- Welcomed guests upon arrival, assisted with check-in processes, and efficiently directed to rooms.
- Maintained a clean and organised reception area, creating a welcoming environment for guests.
Client partner- revenue cycle
Access Healthcare
Pasay City, Philippines
02.2022 - 10.2022
- Followed up on medical claims to ensure timely payments
- Analysed claim processing to identify trends and areas for improvement
- Resolved underpayments and denials to maximise revenue recovery
- Profecient in utilizing insurance portal
- Navigated eligibility and COB denial processes
Customer Care Representative
Conduent
Pasay City, Philippines
10.2018 - 02.2022
- Managed high-volume calls to efficiently address customer queries, ensuring timely resolution.
- Resolved customer complaints with empathy and professionalism, fostering satisfaction and loyalty.
- Facilitated customer service inquiries via phone, email, and live chat, delivering accurate responses to enhance customer experience.
Education
Bachelor of Science in Business Management
Cavite State University- Rosario
Cavite01-2016
Skills
- Insurance verification
- Problem resolution
- Analytical and critical thinking
- Attention to detail
- Time management
- Effective communication
- Communication skills
- Willingness to learn
- Calm under pressure
- Problem-solving
Timeline
Medical Claims Analyst
Med-Metrix
08.2025 - Current
Front Desk Receptionist
Tanba-Chigui Ban&CO Inc.
03.2023 - 06.2025
Client partner- revenue cycle
Access Healthcare
02.2022 - 10.2022
Customer Care Representative
Conduent
10.2018 - 02.2022
Bachelor of Science in Business Management
Cavite State University- Rosario