Global Health Claims Specialist

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

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