Claims Staff

International Marketing Group; Makati; On-site; PHP 300,000 - 600,000; Full time

Job summary

International Marketing Group is seeking a detail-oriented Claims Specialist to process and manage health insurance claims for a global member base. You will verify documentation, adjudicate claims, and coordinate with TPAs and providers to ensure timely, accurate decisions.

The role requires knowledge of ICD/CPT coding, strong communication, and meticulous record-keeping. Candidates should have at least 6 months to 1 year in health insurance claims processing and be proficient with MS Office

Qualifications

• Bachelor’s degree in Healthcare Administration, Insurance, Business, or related field.
• Minimum 6 months to 1 year of experience in health insurance claims processing or a similar role, preferably in an international environment.
• Strong knowledge of international health insurance plans, policy terms, ICD/CPT coding, and claims adjudication processes.
• Excellent communication and interpersonal skills, with a customer-centric approach.
• High attention to detail and strong organizational skills.
• Proficient in claims management systems and Microsoft Office tools (Excel, Outlook, Word).

Responsibilities

• Review, evaluate, and process health insurance claims in accordance with policy terms, medical necessity, and internal guidelines
• Verify submitted documentation, including medical records, invoices, and prescriptions, for accuracy and completeness
• Coordinate with healthcare providers, policyholders, and third-party administrators (TPAs) to resolve claim discrepancies
• Ensure claims decisions (approvals, rejections, or escalations) are made within established service level agreements (SLAs)
• Maintain accurate records of claims processed and provide timely reporting to management
• Assist with fraud detection, investigation, and prevention processes
• Provide guidance and support to customers regarding the status of their claims and required documentation
• Ensure adherence to local and international insurance regulations, data protection laws, and company compliance standards
• Support process improvement initiatives and assist with the development of claims processing policies and workflows

Skills

Communication

Interpersonal skills

Attention to detail

Customer-centric

Organizational skills

Health insurance knowledge

Education

Bachelor’s degree in Healthcare Administration, Insurance, Business, or related field

Tools

MS Office

Claims management systems

ICD/CPT coding

Job description

Job Summary:

We are seeking a detail-oriented and customer-focused Claims Specialist to join our dynamic team within a leading International Health Group of Companies. The ideal candidate will be responsible for processing and managing health insurance claims efficiently and accurately, while ensuring compliance with company policies and regulatory standards. This role plays a key part in delivering a high-quality service experience to members, providers, and partners globally.

Key Responsibilities:

• Review, evaluate, and process health insurance claims in accordance with policy terms, medical necessity, and internal guidelines

• Verify submitted documentation, including medical records, invoices, and prescriptions, for accuracy and completeness

• Coordinate with healthcare providers, policyholders, and third-party administrators (TPAs) to resolve claim discrepancies

• Ensure claims decisions (approvals, rejections, or escalations) are made within established service level agreements (SLAs)

• Maintain accurate records of claims processed and provide timely reporting to management

• Assist with fraud detection, investigation, and prevention processes

• Provide guidance and support to customers regarding the status of their claims and required documentation

• Ensure adherence to local and international insurance regulations, data protection laws, and company compliance standards

• Support process improvement initiatives and assist with the development of claims processing policies and workflows

Qualifications:

• Bachelor’s degree in Healthcare Administration, Insurance, Business, or a related field

• Minimum 6 months to 1 year of experience in health insurance claims processing or a similar role, preferably in an international environment

• Strong knowledge of international health insurance plans, policy terms, ICD/CPT coding, and claims adjudication processes

• Excellent communication and interpersonal skills, with a customer-centric approach

• High attention to detail and strong organizational skills

• Proficient in claims management systems and Microsoft Office tools (Excel, Outlook, Word)