Claims Processor

Dempsey Resource Management Inc.; Makati; On-site; PHP 279,000 - 390,600; Full time

Job summary

A healthcare resource management firm is seeking a Medical Claims Processor in Makati. Responsibilities include reviewing and processing medical claims, verifying member eligibility, and ensuring compliance with HMO rules. Candidates should have a Bachelor’s degree in Business Administration or related fields, and 1-2 years of relevant experience in medical claims processing or administrative support. Familiarity with medical billing is preferred.

Qualifications

• 1-2 years of relevant experience in medical claims processing or administrative support in healthcare.
• Familiarity with HMO procedures and healthcare provider networks is a plus.

Responsibilities

• Review and process medical claims submitted by members or healthcare providers.
• Check documents for completeness, including medical abstracts and itemized statements.
• Verify member eligibility and benefits coverage.

Skills

Medical claims processing

Attention to detail

Familiarity with medical billing

Education

Bachelor’s degree in Business Administration, Healthcare Management, Nursing

Job description

Review and process medical claims submitted by members or healthcare providers.

Check documents for completeness, including medical abstracts, itemized statements, and official receipts.

Verify member eligibility, benefits coverage, and policy limits.

Apply appropriate coding and benefits computation based on the member’s plan and HMO rules.

Bachelor’s degree in Business administration, Healthcare Management, Nursing, or a related field is preferred.

A diploma in medical, healthcare, or business-related field may be considered.

1-2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries.

Familiarity with medical billing and reimbursement processes.

Experience working with HMO procedures and healthcare provider networks is a plus.