Claims Processor | Healthcare | Onsite

TerraBarn Inc; Makati; On-site; PHP 279,000 - 446,000; Full time

Job summary

InLife Benefits in Makati is seeking a Claims Assistant to provide end-to-end support for employee healthcare and insurance benefits. You will be the main contact for HMO inquiries, coordinate inpatient admissions, and guide beneficiaries on coverage and eligibility.

The role involves handling reimbursements, coordinating with the Claims Department, and maintaining confidential benefit records while delivering excellent service to client employees.

Qualifications

• Bachelor's degree in a related field (HR, Psychology, Business, Healthcare, or Nursing).
• 1 year of experience in Employee Benefits, HMO Administration, Healthcare, Insurance, Customer Service, HR, or Claims Processing.
• Fresh graduates with internship experience are encouraged to apply.
• Knowledge of HMO, employee healthcare benefits, insurance claims, and reimbursements is advantageous.

Responsibilities

• Serve as the primary contact for employees regarding HMO, insurance, and healthcare benefit inquiries.
• Assist employees with inpatient admissions by coordinating with the Call Center Team and endorsing cases.
• Provide guidance on benefit eligibility, coverage, and utilization.
• Coordinate medical reimbursement claims and track status.
• Maintain accurate employee benefit records with confidentiality.

Skills

Customer service

Interpersonal communication

Organizational skills

Multitasking

MS Office

CRM/HRIS usage

Education

Bachelor's degree

Tools

Microsoft Office

HRIS

CRM

Job description

About InLife Benefits (Makati)

InLife Benefits is a leading provider of healthcare and employee benefits administration services in the Philippines.

Job Summary

The Claims Assistant is responsible for providing end-to-end support for employee healthcare and insurance benefits. This role serves as the primary point of contact for employees regarding HMO, medical claims, reimbursements, provider coordination, and wellness programs.

Key Responsibilities

Employee Benefits Administration

• Serve as the primary contact for employees regarding HMO, insurance, and healthcare benefit inquiries.
• Assist employees with inpatient admissions by coordinating with the Call Center Team and ensuring timely endorsement of cases.
• Provide guidance on employee benefits, eligibility, coverage, and benefit utilization.
• Assist employees with benefit-related concerns and elevate complex case when necessary.

Claims and Reimbursements

• Coordinate and monitor medical reimbursement claims submitted by employees.
• Track claim status and provide timely updates on approvals, denials, and pending requirements.
• Coordinate with the Claims Department to facilitate efficient processing of medical claims.
• Ensure accurate documentation and proper filing of all benefit-related records.

Provider Coordination

• Coordinate with accredited hospitals, clinics, physicians, and healthcare providers regarding employee healthcare services.
• Liaise with the PNAD (Accreditation) Team for provider accreditation requests and concerns.
• Facilitate communication between employees and healthcare providers to ensure quality service delivery.

Reporting and Documentation

• Prepare and submit daily, weekly, and monthly operational reports within established deadlines.
• Assist in preparing monthly reports on employee hospital admissions and utilization data.
• Maintain accurate employee benefit records while ensuring confidentiality of sensitive information.

Employee Wellness Programs

• Coordinate Annual Physical Examinations (APE), Executive Check-ups, and wellness initiatives for client accounts.
• Support health awareness campaigns and employee wellness activities.
• Assist employees with lost HMO card replacements and benefit-related documentation.

Customer Service and Operations

• Provide exceptional customer service by responding promptly to employee inquiries.
• Direct employees to the appropriate support channels during weekends, holidays, and after-office hours.
• Promote company programs and initiatives to employees.
• Perform other duties related to employee benefits administration as assigned.

Qualifications

• Bachelor's degree in Human Resources, Psychology, Business Administration, Healthcare Administration, Nursing, or any related field.
• At least 1 year of experience in Employee Benefits, HMO Administration, Healthcare, Insurance, Customer Service, HR, or Claims Processing.
• Fresh graduates with relevant internship experience are encouraged to apply.
• Knowledge of HMO, employee healthcare benefits, insurance claims, and reimbursement processes is an advantage.
• Strong customer service and interpersonal communication skills.
• Excellent organizational skills with keen attention to detail.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Proficient in Microsoft Office applications (Excel, Word, Outlook, and PowerPoint).
• Experience using HRIS, CRM, or benefits management systems is an advantage.
• Ability to handle confidential employee information with professionalism and integrity.
• Willing to work onsite and support multiple client accounts when necessary.