Healthcare Claims Adjudication Specialist

RELIANCECARE INC.; Mandaluyong; On-site; PHP 240,000 - 360,000; Full time

Job summary

RELIANCECARE INC. in Mandaluyong, Metro Manila is hiring a Claims Processor to join our healthcare benefits team. You will accurately capture and maintain claim data, review and adjudicate claims, and resolve discrepancies to meet SLAs.

Qualified candidates have a Bachelor’s degree in a health-related field, at least 2 years in health insurance or HMO benefits, and are willing to work onsite in Mandaluyong.

Qualifications

• Bachelor’s degree in a health-related field (Pharmacy, Nursing, Medical Technology or allied health).
• At least 2 years of experience in health insurance/HMO policies, benefits and coverage.
• Experience in TPA, HMO, insurance, or insurance brokerage is preferred.
• Currently residing in Metro Manila and willing to work onsite in Mandaluyong.

Responsibilities

• Accurately capture and maintain claim data, transactions, and records in the claims management system.
• Review and adjudicate claims by verifying completeness, eligibility, coverage, and compliance with benefit plan terms.
• Investigate and resolve claim discrepancies by coordinating with members, departments, and relevant stakeholders.
• Address inquiries, provide claim status and benefit information, and resolve concerns in accordance with established SLAs.

Skills

Attention to detail

Organizational skills

Healthcare benefits knowledge

Education

Bachelor’s degree in health-related field

Job description

RELIANCECARE INC. in Mandaluyong, Metro Manila is hiring a Claims Processor to join our healthcare benefits team. You will accurately capture and maintain claim data, review and adjudicate claims, and resolve discrepancies to meet SLAs.

Qualified candidates have a Bachelor’s degree in a health-related field, at least 2 years in health insurance or HMO benefits, and are willing to work onsite in Mandaluyong.