Healthcare Claims Investigator & Resolution Specialist

Optum Philippines; Makati; On-site; PHP 300,000 - 420,000; Full time

Job summary

Optum Philippines is seeking a detail‑oriented professional to provide claims expertise support across health plans and government entities. You will review, investigate, negotiate and resolve diverse claims while ensuring compliance with policies and regulatory requirements.

The role involves analyzing trends, generating reports, and managing subrogation files within a fast-paced environment. A 4‑year college degree and 1+ year of claims experience are required, with opportunities for growth

Qualifications

• College graduate of any 4 year course.
• 1+ years of claims or collections experience.
• 1+ year of experience analyzing and solving customer problems.

Responsibilities

• Provide claims expertise support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities.
• Analyze, identify trends and provide reports as necessary.
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
• Manage subrogation files.
• Adhere to employment contracts and company policies, including flexible work arrangements and policy changes.

Skills

Claims experience

Customer problem solving

Reporting

Education

Bachelor's degree (4-year)

Job description

Optum Philippines is seeking a detail‑oriented professional to provide claims expertise support across health plans and government entities. You will review, investigate, negotiate and resolve diverse claims while ensuring compliance with policies and regulatory requirements.

The role involves analyzing trends, generating reports, and managing subrogation files within a fast-paced environment. A 4‑year college degree and 1+ year of claims experience are required, with opportunities for growth