Claims Processor

RELIANCECARE INC.; Mandaluyong; On-site; PHP 240,000 - 360,000; Full time

Job summary

RELIANCECARE INC. in Mandaluyong, Metro Manila is hiring a Claims Processor to join our healthcare benefits team. You will accurately capture and maintain claim data, review and adjudicate claims, and resolve discrepancies to meet SLAs.

Qualified candidates have a Bachelor’s degree in a health-related field, at least 2 years in health insurance or HMO benefits, and are willing to work onsite in Mandaluyong.

Qualifications

• Bachelor’s degree in a health-related field (Pharmacy, Nursing, Medical Technology or allied health).
• At least 2 years of experience in health insurance/HMO policies, benefits and coverage.
• Experience in TPA, HMO, insurance, or insurance brokerage is preferred.
• Currently residing in Metro Manila and willing to work onsite in Mandaluyong.

Responsibilities

• Accurately capture and maintain claim data, transactions, and records in the claims management system.
• Review and adjudicate claims by verifying completeness, eligibility, coverage, and compliance with benefit plan terms.
• Investigate and resolve claim discrepancies by coordinating with members, departments, and relevant stakeholders.
• Address inquiries, provide claim status and benefit information, and resolve concerns in accordance with established SLAs.

Skills

Attention to detail

Organizational skills

Healthcare benefits knowledge

Education

Bachelor’s degree in health-related field

Job description

We're Hiring Claims Processor!

Join our team and help ensure a smooth and efficient employee benefits experience. If you have strong attention to detail, excellent organizational skills, and an interest in healthcare benefits, we would love to hear from you.

Key Responsibilities:

• Accurately capture and maintain claim data, transactions, and records in the claims management system.
• Review and adjudicate claims by verifying completeness, eligibility, coverage, and compliance with benefit plan terms.
• Investigate and resolve claim discrepancies by coordinating with members, departments, and relevant stakeholders.
• Address inquiries, provide claim status and benefit information, and resolve concerns in accordance with established SLAs.

Qualifications:

• College Graduate with a Bachelor’s degree in a health-related field, such as Pharmacy, Nursing, Medical Technology, or other allied health programs
• At least 2 years of relevant work experience (health insurance/HMO policies, benefits, and coverage)
• Experience in TPA, HMO, insurance, or insurance brokerage is preferred.
• Currently residing in Metro Manila and willing to work onsite in Mandaluyong.

Join our team as a Claims Processor and start building a rewarding career in healthcare today!