Claims Supervisor

Maxicare Healthcare Corporation; Cebu City; On-site; PHP 360,000 - 420,000; Full time

Job summary

Maxicare Healthcare Corporation is seeking a Claims Supervisor to oversee reconciliation between Maxicare and providers, ensuring timely resolution and accurate payment of claims.

The role involves monitoring reconciliation workflows, coordinating with internal units, and developing provider relationships to improve operational efficiency and data accuracy.

Responsibilities

• Reconciles the claims records between Maxicare and providers including clinics, and physicians.
• Ensures complete resolution and payment of all claims identified during reconciliation within the agreed turnaround time.
• Updates the centralized monitoring report of all received requests for reconciliation.
• Coordinates with other units to resolve payment issues and concerns.
• Escalates issues encountered or reported by the provider to the concerned unit for handling or approval.
• Requests and secures Clearance Certificate from providers.
• Analyzes trends in claims data to identify root causes of discrepancies and recommends solutions.
• Develops and maintains strong relationships with providers to facilitate timely resolution of reconciliation issues.
• Prepares reports and presentations on reconciliation performance metrics and findings for management review.
• Serves as a subject matter expert on claims reconciliation processes and procedures, providing guidance to colleagues as needed.

Job description

Job Description:

Group Company: Maxicare Healthcare Corporation

Designation: Claims

Office Location: Robinsons Cybergate Cebu

Position description: Claims Supervisor

Primary Responsibilities

• Reconciles the claims records between Maxicare and providers including clinics, and physicians.

Additional Responsibilities

• Ensures complete resolution and payment of all claims that are identified during reconciliation that requires processing within the agreed turnaround time and settlement.
• Ensures updated information on the centralized monitoring report of all received requests for reconciliation.
• Coordinates with other units to resolve the payment issues and concerns.
• Escalates issues encountered or reported by the provider to the concerned unit or department for their handling or recommendation or approval.
• Requests and secures Clearance Certificate from providers.
• Analyze trends in claims data to identify root causes of discrepancies and recommend solutions to prevent future errors.
• Develop and maintain strong relationships with providers to facilitate open communication and timely resolution of reconciliation issues.
• Prepare reports and presentations on reconciliation performance metrics and findings for management review.
• Serve as a subject matter expert on claims reconciliation processes and procedures, providing guidance and support to colleagues as needed.

Reporting Team

• Reporting Designation: Health Network Management
• Reporting Department: Claims

Required Work Experience

• Years of experience: 0-1 year