Healthcare Claims Representative

Optum Philippines; Makati; On-site; PHP 500,000 - 700,000; Full time

Job summary

Optum Philippines is seeking an experienced claims professional to provide expert support in reviewing, researching, negotiating, and resolving complex health plan claims. You will analyze trends and generate reports while ensuring compliance with policies and contracts.

The role requires adaptability to policy changes and various work arrangements. Ideal candidates have 4+ years in claims recovery and resolution and strong proficiency with Windows PC applications.

Qualifications

• College graduate of any 4 year course.
• 4+ years of experience in claims recovery and resolution.
• Proficiency with computer and Windows PC applications.
• Proven ability to multitask across multiple products and benefits.

Responsibilities

• Provide expertise claims support by reviewing, researching, negotiating and resolving all types of claims.
• Analyze and identify trends and provide reports.
• Ensure adherence to applicable compliance policies and contract terms.
• Remain adaptable to policy changes and work location arrangements.

Skills

Claims processing

Data analysis

Windows proficiency

multitasking

Education

4-year college degree

Tools

Windows OS

Job description

Overview

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.

Caring. Connecting. Growing together.

Responsibilities

• Provide expertise claims 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 and identify trends and provide reports as necessary
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Qualifications

• College graduate of any 4 year course
• 4+ years of experience in claims recovery and resolution
• Proficiency with computer and Windows PC applications, including the ability to learn new and complex computer system applications
• Proven ability to multi-task, including the ability to understand multiple products and multiple levels of benefits within each product

Physical Requirements and Work Environment

• Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone — of every race, gender, sexuality, age, location and income — deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Optum is a drug-free workplace. © 2026 Optum Global Solutions (Philippines) Inc. All rights reserved.