Benefits Claims Adjudication Specialist

ActiveOne Health, Inc.; Mandaluyong; On-site; PHP 240,000 - 300,000; Full time

Job summary

ActiveOne Health, Inc. is seeking a Claim Processor to handle timely processing, adjudication and eligibility verification of health benefit claims at our Greenfield District, Mandaluyong office.

You will review submissions, enter data into the claims system, and communicate issues to the appropriate departments as needed. The ideal candidate holds a Bachelor’s degree in health/medical allied fields and has at least 2 years of related experience, preferably in TPA, HMO, insurance, or broker

Qualifications

• Bachelor's/College Degree in health/medical allied fields is required.
• At least 2 years of working experience in related field.

Responsibilities

• Accurately captures claim data into the claims management system and maintains updated records of all claim transactions, communications, and outcomes.
• Analyze claims for completeness, accuracy, and compliance with the member’s benefit plan terms.
• Confirm member eligibility for benefits and verify coverage under current plan.
• Adjudicate and authorize payments or refer/escalate claims for further review.
• Investigate and resolve discrepancies by gathering information from members and stakeholders.
• Inform employees on progress of their claims based on SLA.
• Respond to inquiries or complaints in line with SLA.

Education

Bachelor's/College Degree in health / medical allied courses

Job description

ActiveOne Health, Inc. is seeking a Claim Processor to handle timely processing, adjudication and eligibility verification of health benefit claims at our Greenfield District, Mandaluyong office.

You will review submissions, enter data into the claims system, and communicate issues to the appropriate departments as needed. The ideal candidate holds a Bachelor’s degree in health/medical allied fields and has at least 2 years of related experience, preferably in TPA, HMO, insurance, or broker