Claims Manager

MEDICARE PLUS, INC.; Pasig; On-site; PHP 400,000 - 650,000; Full time

Job summary

MEDICARE PLUS, INC. is seeking an experienced claims adjudicator to review and resolve healthcare claims.

The role involves investigating doubtful claims, calculating benefits, and ensuring timely payments while maintaining accurate documentation and client service standards. The ideal candidate has a medical-related degree (advantageous) and at least four years in healthcare, insurance, or BPO, with strong communication and multitasking abilities.

Qualifications

• Bachelor’s degree in a medical-related field is an advantage.
• At least 4 years of relevant experience in Healthcare, Insurance, or BPO.
• Excellent verbal and written communication skills.
• Proficient in Windows OS, MS Office applications.
• Knowledge of medical and insurance terminologies.
• Critical thinking with focus on issue resolution and customer satisfaction.
• Can multitask and has high attention to detail.

Responsibilities

• Adjudicates claims.
• Initiates or conducts investigations of questionable claims.
• Resolves claims by approving or denying, calculating benefits due, initiating payment, preparing notice to member after adjudication by indicating remarks in the system.
• Documents medical claims by preparing worksheets for inpatient cases, data entry, reports, logs, and records.
• Maintains quality services by following client service practices and responding to customer inquiries.
• Performs second-layer checking of claims proposed by junior assessors.
• Handles specific portfolios with specific service agreement.

Skills

Adjudication

Investigation

Claims processing

Documentation

Customer service

Quality assurance

Multitasking

Education

Bachelor’s degree in a medical-related field

Tools

Windows OS

MS Office

Job description

Responsibilities:

• Adjudicates claim
• Initiates or conducts investigations of questionable claims
• Resolves claims by approving or denying, calculating benefits due, initiating payment, preparing notice to member after case adjudication by indicating remarks in the system
• Documentations of the medical claims by preparing worksheets for inpatient cases, data entry in the system, reports, logs, and records
• Maintains quality services by following client service practices and responding to customer inquiries
• Performs second-layer checking of claims proposed by junior assessors
• Handles specific portfolios with specific service agreement

Qualifications:

• Bachelor’s degree in a medical-related field is an advantage
• At least 4 years of relevant experience in the Healthcare, Insurance, or BPO industry
• Excellent verbal and written communication skills
• Proficient in Windows OS, MS Office applications
• Has a Knowledge of medical and insurance terminologies
• Has critical thinking skills with a focus on issue resolution and customer satisfaction
• Can multitask and has a high attention to details