Claims Officer/ Supervisor

TerraBarn Inc; Cebu City; On-site; PHP 420,000 - 640,000; Full time

Job summary

TerraBarn Inc. is seeking a seasoned Claims Officer to process medical and life insurance claims, verify details, and prepare payments within authority limits. You will reconcile provider statements and coordinate with assigned accounts, ensuring timely resolution of disputes.

The role requires a college degree in a medical or business field, 5+ years in claims processing, and 2–3 years in an officer or supervisory capacity. LO MA courses are preferred.

Qualifications

• College degree in medical or business field.
• 5+ years of claims processing experience (medical or life).
• 2–3 years in officer/supervisory role.
• LOMA courses preferred.

Responsibilities

• Process and analyze medical and life claims per policy and guidelines.
• Verify claim details, prepare transmittals, approve payments within limits.
• Reconcile claims with providers and accounts.
• Conduct UAT for system enhancements and provide findings.
• Respond to inquiries about claim status or payments within TAT.
• Escalate disputes or complaints when needed.

Skills

Claims processing

Supervisory leadership

UAT testing

Education

Bachelor's degree in medical or business field

LOMA courses (preferred)

Job description

About the role

The Claims Officer (PS4) is responsible for processing and analyzing medical and life insurance claims using prescribed processes and existing policy contracts and guidelines. The role involves verifying claim details, preparing transmittals for payment, approving claims within authority limits, and reconciling claims with providers. The Claims Officer also conducts user acceptance testing (UAT) of system enhancements, provides customer service regarding claims status and payment inquiries, reconciles provider statements of account, and maintains effective relationships with assigned accounts through regular coordination and timely resolution of claims-related concerns.

Key responsibilities

• Check availability and accuracy of claims details in MAS and make necessary corrections

• Verify unlisted claims in MAS with biller and Alarm Center

• Process and analyze claims using prescribed processes and based on existing policy contract and guidelines

• Prepare transmittal of claims for payment

• Approve payment for claims within authority limit

• Recommend approval of claims payment beyond authority limit

• Reconcile claims with providers and accounts

• Conduct UAT of system enhancements and provide analysis and findings

• Answer inquiries via email or phone regarding status of claims or overdue payments within set turn-around time

• Document, resolve, or escalate claims disputes or complaints within TAT

About you

• College graduate with a degree in any medical or business-related discipline

• At least 5 years' experience in medical or life claims processing

• At least 2 – 3 years' experience at officer or supervisory level

• Preferably passed Life Office Management Association (LOMA) courses