HMO Claims & Benefits Specialist

HR Network Inc.; Lapu-Lapu; On-site; PHP 240,000 - 360,000; Full time

Job summary

HR Network Inc. in the Philippines is seeking a Claims Support Specialist to assist members with benefits, LOA, claims, confinement, and discharge concerns.

The role involves coordinating with accredited doctors and providers to file LOAs and check claim payment status. Ideal candidates hold a medical-related degree or a four-year course, have at least 3 years of HMO/insurance experience, and are proficient in Google Workspace and Microsoft Office.

Qualifications

• Graduate of a medical-related course (preferred), or any four-year course.
• With at least 3 years of experience in HMO and Insurance.
• Proficient in Google Workspace and Microsoft Office applications.
• With excellent written and verbal communication skills.
• Available for immediate employment.
• Willing to work in Lapu-Lapu City, Cebu.

Responsibilities

• Assist members with their benefits, LOA, claims, confinement, and discharge concerns.
• Assist accredited doctors and providers with LOA filing and claim payment status.
• Review claims and check if charges are within the company’s approved rates and guidelines.
• Coordinate with Mactan Doctors Hospital and nearby accredited providers regarding service-related concerns.
• Collect claims from accredited doctors at least once a week.
• Coordinate with clients, members, and healthcare providers to resolve claims and service concerns.
• Support the improvement of claims processing and other related healthcare services.

Skills

Excellent communication skills

Education

Medical-related degree or four-year course

3+ years in HMO/Insurance

Tools

Google Workspace

Microsoft Office

Job description

HR Network Inc. in the Philippines is seeking a Claims Support Specialist to assist members with benefits, LOA, claims, confinement, and discharge concerns.

The role involves coordinating with accredited doctors and providers to file LOAs and check claim payment status. Ideal candidates hold a medical-related degree or a four-year course, have at least 3 years of HMO/insurance experience, and are proficient in Google Workspace and Microsoft Office.