Claims Officer

EdirectInsure Group; Philippines; On-site; PHP 600,000 - 1,200,000; Full time

Job summary

EdirectInsure Group in the Philippines is seeking a seasoned professional to lead the medical claims support team. You will drive KPI-driven performance, monitor claim activities, and ensure service quality and compliance across processes.

The role requires 5–8 years in insurance or related fields, strong leadership, and excellent English communication to coordinate with multiple functions and ensure customer-centric outcomes.

Qualifications

• Graduation in any stream or ITI or Diploma in Mobile Repair or related field.
• 5 - 8 years of relevant experience in Insurance industry or any brand repair center.
• Experience in claim processing.
• Backend operation experience (Insurance, Banking & Finance)
• Team handling experience.
• Possess good leadership, achieve cooperation and collaboration among all functions.
• Good communication and interpersonal skills
• Good verbal and written communication skills in English.
• Customer-centric mindset are advantageous.
• Highly motivated and able to work independently.

Responsibilities

• Manage, develop and lead the team to achieve the targeted KPI.
• Monitor and manage claim activities to ensure delivered service as commitment.
• Build-up SLA and KPI, measure performance for the team, conduct performance reviews and provide input into discussions around individual performance.
• Scrutinize claims processed by Claims executives for accuracy and efficiency.
• Ensure SOPs are followed by all executives and process compliance is optimal.
• Analyze and deep dive in complaints to not only give out solutions but also keep brand name of the client and the company
• Conduct coach session/ training to improve and enhance CA’s knowledge.
• Provide Activity Report as Team performance report daily, weekly and monthly bases.

Skills

Curious

Communication

Collaborative

Adaptable

Education

Graduation in any stream or ITI or Diploma in Mobile Repair or related field

Job description

In this position you will....

will be involved in medical claims by determining insurance coverage; examining and resolving medical claims; complete documentation; maintaining quality customer services and ensuring legal compliance.

You will be responsible for…

• Manage, develop and lead the team to achieve the targeted KPI.
• Monitor and manage claim activities to ensure delivered service as commitment.
• Build-up SLA and KPI, measure performance for the team, conduct performance reviews and provide input into discussions around individual performance.
• Scrutinize claims processed by Claims executives for accuracy and efficiency.
• Ensure SOPs are followed by all executives and process compliance is optimal.
• Analyze and deep dive in complaints to not only give out solutions but also keep brand name of the client and the company
• Conduct coach session/ training to improve and enhance CA’s knowledge.
• Provide Activity Report as Team performance report daily, weekly and monthly bases.

For you to be successful…

We expect you to be able to demonstrate the following key competencies

Curious

• Motivated and self-directed, identifying opportunities to grow and acquire new knowledge from a range of sources. Has a sound comprehension of relevant multi-discipline areas of expertise.

• Demonstrates reflection and solicits feedback from others.Evaluates and learns from set-backs and adversity.

Communication

• Effective and articulate communicator actively and respectfully listens to and synthesizes others’ perspectives.

• Concise in communicating and references relevant information tailored to the audience to support points.

Collaborative

• Inclusive, empathetic and encourages and facilitates other team members to unite and deliver positive results.
• Develops strategic relationships and networks across the organization and shares with others for mutual benefit.

Adaptable

• Is quick to adapt approach and act flexibly in response to changes in the strategic and/or operational direction of the organization.
• Modifies style and leverages different approaches depending on different situations and circumstances.

You will require the following qualifications and skills

• Graduation in any stream or ITI or Diploma in Mobile Repair or related field.
• 5 - 8 years of relevant experience in Insurance industry or any brand repair center
• Experience in claim processing.
• Backend operation experience (Insurance, Banking & Finance)
• Team handling experience.
• Possess good leadership, achieve cooperation and collaboration among all functions.
• Good communication and interpersonal skills
• Good verbal and written communication skills in English.
• Customer-centric mindset are advantageous.
• Highly motivated and able to work independently.