Claims Specialist

SPD Jobs Incorporated; Makati; On-site; PHP 223,200 - 279,000; Full time

Benefits offered by this job

Government Mandated Benefits

Insurance Health & Wellness

Professional Development

Job summary

A local recruitment agency is seeking a Claims Processor in Makati. This role involves analyzing and processing claims based on guidelines, requiring a bachelor's degree. Fresh graduates are encouraged to apply. The position offers on-site work at Omnis Prosperity Tower in Makati City.

Qualifications

• Graduate of any 4-year course.
• Fresh graduates are welcome to apply.

Responsibilities

• Analyze and process various claims according to medical guidelines.
• Liaise with clients and healthcare providers for clarifications.
• Ensure compliance with relevant regulations.

Education

Bachelor's degree

Job description

On-site - Makati Fresh Graduate/Student Bachelor Full-time

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Job Description

Government Mandated Benefits

Insurance Health & Wellness

Professional Development

Job Training

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• Responsible for analyzing, adjudicating, auditing, and processing of claims (In-Patient, Outpatient Hospital Bills and Professional Fees) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements)
• Analyze claim submissions to verify policyholder and provider information, ensuring accuracy and completeness against submitted documentation.
• Liaise with clients, insurance agents, beneficiaries, healthcare providers, and other departments to gather information, resolve issues, and provide updates on claim status.
• Prepare and maintain accurate records of all claim activities and policy information, often using specialized database systems.
• Determine policy coverage, calculate the appropriate claim amounts, and process payments or other reimbursements.
• Ensure all claim processing activities adhere to company policies, procedures, and relevant state and federal regulations.
• Investigate and resolve any discrepancies or issues that arise during the claim process.

Qualifications

• Graduate of any 4-year course.
• Fresh graduates are welcome to apply.

Preview

Recruitment Supervisor SPD Jobs Incorporated

Active within three days

Working Location

Omnis Prosperity Tower. Omnis Prosperity Tower, 379 Sen. Gil J. Puyat Ave, Makati City, Metro Manila, Philippines

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