Claims Specialist (Non-life)

Comrise; Muntinlupa; On-site; PHP 350,000 - 550,000; Full time

Job summary

Comrise in the Philippines is seeking an experienced Claims Specialist to join our team. The role focuses on reviewing complex or high-priority claims, verifying documentation, and ensuring compliance with policies and regulations.

You will process claims within established timelines, assist in settlements, handle escalations, and contribute to quality assurance and reporting. A background with 3-4 years in claims is preferred and a related degree is a plus.

Qualifications

• At least 3-4 years of experience in claims processing or a related field.
• Strong understanding of claims management and procedures.
• Experience with verification of supporting documentation (medical records, receipts, proof of loss).
• Ability to handle escalations and ensure compliance with policies and regulations.
• Participation in audits and continuous improvement of claims processes.

Responsibilities

• Claims Review & Assessment: Handle complex or high-priority claims with complete, accurate documentation.
• Claims Processing: Process claims within established timelines and determine actions for approval, rejection, or escalation.
• Claims Settlement: Assist in determining settlements or payouts per company guidelines.
• Escalation Management: Manage escalated claims and provide solutions as a subject matter expert.
• Quality Assurance: Review claims data for accuracy and suggest improvements.
• Follow-up: Obtain missing documentation from clients, providers, or internal teams.
• Compliance & Adherence: Ensure processing complies with policies, industry regulations, and legal requirements.
• Team Leadership & Mentorship: Guide and train junior staff and assist with onboarding.
• Reports: Generate regular claims status reports and identify trends or bottlenecks.

Skills

Claims processing

Claims management

Education

Associate's or Bachelor's degree (related field)

Job description

Education: Associate's or Bachelor's degree in a related field is a plus

• Experience: At least 3-4 years of experience in claims processing or a related field, with a strong understanding of claims management and procedures.
• Key Responsibilities:
• Claims Review & Assessment: Handle more complex or high-priority claims, ensuring all documentation is complete, accurate, and in
• compliance with relevant policies and regulations. Verify supporting documentation, such as medical records, receipts, or proof of loss.
• Claims Processing: Process claims within established timelines, ensuring the appropriate action is taken for claim approval, rejection, escalation.
• Claims Settlement: Assist in determining settlements or payouts in accordance with company guidelines, policies, and procedures, ensurin fairness and accuracy.
• Escalation Management: Handle escalated claims or issues that cannot be resolved by junior sta, ensuring timely and eective solutions. Ac as a subject matter expert for the team.
• Problem Resolution: Identify and resolve minor issues or discrepancies in claims processing. Flag more complex cases to senior sta or managers for further investigation and resolution.
• Quality Assurance: Review and ensure the accuracy of claims data entered by junior sta, making recommendations for corrections and improvements as needed.
• Follow-up: Follow up with clients, healthcare providers, third-party vendors, or internal teams to obtain missing documentation or information required to complete claims.
• Compliance & Adherence: Ensure that all claims are processed according to company policies, industry regulations, and legal requirements.
• Stay updated on relevant laws and regulations related to claims processing. Assist with audits and ensure the department follows proper procedures.
• Claims Coordination: Work closely with Claims Adjusters, Managers, and other departments (e.g., legal, underwriting) to ensure smooth claims processing and resolution. Coordinate actions needed for claims, ensuring timelines are adhered to and proper handling of claims and address any issues that arise.
• Team Leadership & Mentorship: Provide guidance, training, and mentorship to junior Claims Assistants, helping to develop their skills and ensure consistency in claims handling. Assist with onboarding new team members.
• Claims Reporting: Generate and review regular reports on the status of claims, identifying trends, bottlenecks, or issues requiring attention.
• Report any irregularities or discrepancies in claims data to the Claims Supervisor or Manager. Identify any systemic issues or areas for process improvement.
• Administrative Support: Provide general administrative support, including preparing claim-related documentation, reports, and scheduling meetings when necessary.
• Process Improvement: Identify ine efficiencies or recurring issues within the claims process and suggest or implement improvements to streamline workflows and enhance team performance
• Claims Data Management: Maintain accurate records of claims in the system