Benefits Claims Specialist - Adjudication & Impact

Reliance United; Manila; On-site; PHP 279,000 - 390,600; Full time

Job summary

Reliance United is seeking Claim Processors in Manila to ensure timely and accurate processing of employee benefit claims. Candidates should have a Bachelor's degree in health/medical courses and at least 2 years of relevant experience in TPA, HMO, or insurance sectors.

Working onsite from Monday to Friday, you will be responsible for data entry, claim analysis, resolving discrepancies, and responding to employee inquiries. A commitment to detail and communication skills are essential for success in this role.

Qualifications

• Must possess at least a Bachelor's degree in health/medical allied courses like Nursing or Pharmacy.
• 2 years of solid working experience in the related field is required.
• Experience in TPA, HMO, insurance, or insurance broker companies is preferred.
• Ability to work onsite and extend beyond normal hours if needed.

Responsibilities

• Accurately capture claim data into the claims management system.
• Analyze claims for completeness, accuracy, and compliance with benefit plans.
• Confirm member's eligibility and verify coverage services.
• Adjudicate and authorize appropriate payments or escalate claims as needed.
• Investigate and resolve discrepancies related to eligible benefits.
• Inform employees on the progress of their claims.
• Respond to employee inquiries and complaints.

Skills

Attention to detail

Analytical skills

Communication skills

Education

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

Job description

Reliance United is seeking Claim Processors in Manila to ensure timely and accurate processing of employee benefit claims. Candidates should have a Bachelor's degree in health/medical courses and at least 2 years of relevant experience in TPA, HMO, or insurance sectors.

Working onsite from Monday to Friday, you will be responsible for data entry, claim analysis, resolving discrepancies, and responding to employee inquiries. A commitment to detail and communication skills are essential for success in this role.