Claims Assistant Manager - Makati

TerraBarn Inc; Makati; On-site; PHP 900,000 - 1,500,000; Full time

Job summary

TerraBarn Inc is seeking an experienced Claims Administrator to manage medical and life claims processing, reconciliation, and provider coordination in a fast-paced environment in Metro Manila. You will lead claims assessment, ensure accuracy, and support UAT testing for system enhancements.

The role emphasizes strong analytical skills, customer service excellence, and the ability to coordinate with sales, IT, and other departments to resolve disputes and improve client satisfaction.

Qualifications

• Bachelor's degree in Medical, Healthcare, Business, or another related discipline.
• At least 10 years of experience in Medical or Life Claims Processing.
• At least 3–5 years of experience in an Assistant Manager or supervisory/management role within the same line of work.
• Strong knowledge of medical and/or life insurance claims processing.
• Experience in claims assessment, payment processing, reconciliation, and provider coordination.
• Strong analytical and problem-solving skills.
• Excellent communication and customer service skills.
• Ability to manage claims disputes, escalations, and customer concerns within defined TAT/SLA.
• Experience working with claims systems and participating in UAT/system testing is an advantage.
• Strong stakeholder and account management skills.
• Ability to lead, coordinate, and work effectively with cross-functional teams.

Responsibilities

• Review claims details in the MAS system for availability and accuracy.
• Make necessary corrections and updates to claims information.
• Verify unlisted claims with billers and the Alarm Center.
• Process and analyze claims based on policy contracts, guidelines, and established procedures.
• Prepare claims transmittals for payment.
• Approve claims payments within the assigned authority limit.
• Recommend approval for claims exceeding the authorized limit.
• Reconcile claims with providers and accounts.
• Conduct UAT for system enhancements and improvements.
• Analyze and document UAT findings and recommendations.
• Coordinate with IT on system issues and required enhancements.
• Respond to customer inquiries regarding claims status and overdue payments through email or phone within established TAT.
• Document medical claims disputes, complaints, and related concerns.
• Resolve or escalated claims disputes and complaints within agreed turnaround time.
• Coordinate with Sales and other departments regarding claims and customer concerns.
• Reconcile Statements of Account (SOA) submitted by providers.
• Coordinate with relevant departments regarding reconciliation items.
• Work directly with provider representatives to resolve discrepancies and requests.
• Ensure timely release of reconciled accounts within established SLA.
• Maintain effective relationships with assigned accounts and providers.
• Conduct regular account reviews and coordination.
• Ensure timely resolution of claims-related concerns.
• Support initiatives that improve client satisfaction and account retention.
• Handle other duties, projects, and assignments related to claims operations as required.

Skills

Medical Claims Processing

Life Insurance Claims

Claims Assessment

Claims Administration

Claims Reconciliation

Provider Coordination

Account Reconciliation

Claims Payment

UAT

Customer Service

Claims Dispute Resolution

Account Management

Insurance Operations

Team Leadership

Education

Bachelor's degree in Medical/Healthcare/Business

Job description

The position will also work closely with providers, internal departments, Sales, IT, and other stakeholders to maintain efficient claims operations and quality service delivery.

Key Responsibilities

• Review claims details in the MAS system for availability and accuracy.

• Make necessary corrections and updates to claims information.

• Verify unlisted claims with billers and the Alarm Center.

• Process and analyze claims based on policy contracts, guidelines, and established procedures.

• Prepare claims transmittals for payment.

• Approve claims payments within the assigned authority limit.

• Recommend approval for claims exceeding the authorized limit.

• Reconcile claims with providers and accounts.

User Acceptance Testing (UAT)

• Conduct UAT for system enhancements and improvements.

• Analyze and document UAT findings and recommendations.

• Coordinate with IT on system issues and required enhancements.

Customer Service & Claims Resolution

• Respond to customer inquiries regarding claims status and overdue payments through email or phone within established TAT.

• Document medical claims disputes, complaints, and related concerns.

• Resolve or escalated claims disputes and complaints within agreed turnaround time.

• Coordinate with Sales and other departments regarding claims and customer concerns.

Account Reconciliation

• Reconcile Statements of Account (SOA) submitted by providers.

• Coordinate with relevant departments regarding reconciliation items.

• Work directly with provider representatives to resolve discrepancies and requests.

• Ensure timely release of reconciled accounts within established SLA.

Account & Stakeholder Management

• Maintain effective relationships with assigned accounts and providers.

• Conduct regular account reviews and coordination.

• Ensure timely resolution of claims-related concerns.

• Support initiatives that improve client satisfaction and account retention.

Other Responsibilities

• Handle other duties, projects, and assignments related to claims operations as required.

Qualifications

• Bachelor's degree in Medical, Healthcare, Business, or another related discipline.

• At least 10 years of experience in Medical or Life Claims Processing.

• At least 3–5 years of experience in an Assistant Manager or supervisory/management role within the same line of work.

• Strong knowledge of medical and/or life insurance claims processing.

• Experience in claims assessment, payment processing, reconciliation, and provider coordination.

• Strong analytical and problem-solving skills.

• Excellent communication and customer service skills.

• Ability to manage claims disputes, escalations, and customer concerns within defined TAT/SLA.

• Experience working with claims systems and participating in UAT/system testing is an advantage.

• Strong stakeholder and account management skills.

• Ability to lead, coordinate, and work effectively with cross-functional teams.

Preferred Qualification

• Completion or passing of Life Office Management Association (LOMA) courses is preferred.

Key Skills

Medical Claims Processing | Life Insurance Claims | Claims Assessment | Claims Administration | Claims Reconciliation | Provider Coordination | Account Reconciliation | Claims Payment | UAT | Customer Service | Claims Dispute Resolution | Account Management | Insurance Operations | Team Leadership