Claims Processor| Healthcare Insurance

Allianz PNB Life Insurance, Inc. (formerly PNB Life Insurance Inc.); Makati; On-site; PHP 320,000 - 460,000; Full time

Benefits offered by this job

Competitive Salary

13th and 14th month guaranteed

Performance Incentive Plan / Yearly 1

Job summary

Allianz PNB Life Insurance, Inc. is seeking a Claims Officer to process medical claims for clients in the assigned region. The role focuses on delivering service within 48 hours while ensuring policy terms and tariffs are met. The department operates in a fast-paced, multilingual environment.

The ideal candidate has 1-2 years in medical claims, strong Excel/Word skills, and a customer-centric, detail-oriented approach. Onsite work in Makati is required with flexible shifts.

Qualifications

• 1-2 years experience in a Medical Claims role is required.
• Strong knowledge of Microsoft Office (Excel, Word).
• A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
• Team player with ability to work under deadlines and minimal supervision.

Responsibilities

• Examine and process Claims within the agreed company SLA to guarantee customer satisfaction and retention.
• Use Allianz Partners client database accurately and effectively to ensure reports reflect workload and support target planning.
• Contribute to productivity targets so the SLA is achieved.
• Identify duplicate payments, overbilling, up coding, non-disclosure and fraudulent claims per policy to contain costs.
• Respond to customer inquiries accurately and professionally and liaise with other departments when needed.

Skills

Medical Claims

Microsoft Office

Customer service

Interpersonal skills

Accuracy

Team player

Deadline-oriented

AI tools

AI-driven learning tech

Shift flexibility

Tools

Microsoft Excel

Microsoft Word

Job description

BENEFITS/PERKS

• Competitive Salary

• 13th and 14th month guaranteed

• Performance Incentive Plan / Yearly Bonus

• Retirement Program and Group Life Insurance

JOB DETAILS / ROLE PURPOSE

The role of Claims Officer involves processing medical claims for clients in their assigned region. We ensure a high level of client service while processing claims within an industry leading 48 hours.

The Claims Officer will process Medical Providers' Claims, making sure that services are eligible as per policy terms and conditions, are in correlation with the authorized guarantee of payment given and are paid as per the agreed tariffs with providers.

The Claims Department is an extremely fast paced environment, with many different languages used and a mixture of cultures.

KEY RESPONSIBILITIES

Key responsibilities will include, but are not limited to, the following:

• Examine and process Claims within the agreed company SLA to guarantee customer satisfaction and retention

• Use Allianz Partners client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning

• Contribute to the team and departmental productivity targets so that the agreed SLA is achieved

• In line with the company’s policy on cost containment identify duplicate payments, overbilling, up coding, possible non-disclosure and fraudulent claims

• Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction

KEY REQUIREMENTS

• 1-2 years experience in a Medical Claims role is required

• Strong Knowledge of Microsoft Office (Excel, Word)

• A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.

• Team player

• Ability to demonstrate sounds work ethics.

• Can work with minimal supervision and comfortable working with deadlines

• Must be willing to work onsite in Makati

• Experience with AI-driven adaptive learning technologies and data analysis for personalized training.

• Proficiency in using AI tools for content recommendation, automated assessment, and feedback.

• Flexible working on shifting arrangement

• Comfortable working on Philippine Holidays

• Open with Ad Hoc tasks

• Can start ASAP