Insurance and Claims Coordinator

TeleCure Corporation; Malolos; On-site; PHP 240,000 - 320,000; Full time

Benefits offered by this job

Health & Wellness benefits

Pharmacy discounts

Rice subsidy

13th-month pay

Paid Time Off

Career development opportunities

Job summary

TeleCure Medical and Diagnostic Center is seeking an Insurance and Claims Coordinator to manage end-to-end administrative processing of patient claims with HMOs, PhilHealth, and third-party payors. You will verify eligibility, secure authorizations, and ensure timely submissions while coordinating with multiple departments.

Key duties include claims processing, monitoring, follow-up, and AR endorsement to Accounting.

Qualifications

• Bachelor's degree in a relevant field is required or preferred.
• Experience in healthcare billing, claims processing, revenue cycle management, and related areas is advantageous.
• Strong attention to detail and ability to coordinate across departments is essential.

Responsibilities

• Verify patient eligibility, coverage, and benefits with HMOs, PhilHealth, insurers, and payors.
• Prepare, submit, and monitor claims through appropriate platforms and processes.
• Coordinate with Operations and other departments to obtain missing documentation and ensure compliant submissions.
• Monitor claim status and follow up on delays, denials, or requests for information.
• Endorse processed claims to Accounting for AR recording and reconciliation.
• Maintain confidentiality and ensure compliance with healthcare regulations.

Skills

Attention to detail

Communication skills

Organizational skills

Healthcare billing

Education

Bachelor's degree in Business Administration/Healthcare Administration

Tools

ICD-10

Job description

Job Title: Insurance and Claims Coordinator

Company: TeleCure Medical and Diagnostic Center

Location: TeleCure Medical and Diagnostic Center, 221 Tanjeco St., Brgy. San Vicente, City of Malolos, Bulacan

Employment Type: Full-time

Experience Level: Entry-level

Schedule: 8 hour shift, Monday to Saturday

COMPANY OVERVIEW

At TeleCure, we are committed to making quality healthcare more accessible and convenient for every Filipino. What began as a pandemic response has grown into a healthcare organization focused on delivering accessible, affordable, and patient-centered primary healthcare through integrated medical, pharmacy, laboratory, radiology, and digital services. Join our growing team and be part of a company that combines compassion, operational excellence, and technology to improve the healthcare experience for the communities we serve.

ROLE OVERVIEW

Reporting to the Clinic Supervisor.

• The Insurance and Claims Coordinator is responsible for managing the end-to-end administrative processing of patient claims and receivables involving HMOs, PhilHealth, corporate accounts, insurers, and other third-party payors.

• The role ensures that patient coverage and benefit eligibility are properly verified before or during service provision, required documents are complete and accurate, claims are submitted within prescribed timelines, deficiencies and denied claims are promptly addressed, and successfully processed claims are properly endorsed to Accounting for accounts receivable recognition, monitoring, and collection.

• The Insurance and Claims Coordinator serves as the primary operational link between TeleCure, its patients, third-party payors, and internal departments for matters involving coverage verification, claims processing, authorization, reimbursement, and claims status.

KEY RESPONSIBILITIES

1. Coverage, Eligibility & Benefit Verification

• Verify patient eligibility, membership, coverage, available benefits, and applicable limitations with HMOs, PhilHealth, insurers, corporate accounts, and other third-party payors.
• Secure or facilitate required Letters of Authorization (LOA), approvals, eligibility confirmations, or equivalent documents before service provision when required.
• Determine whether requested services are covered, partially covered, subject to co-payment, or excluded from the patient's benefits.
• Clarify questionable or unclear coverage directly with the appropriate third-party payor.
• Promptly communicate verified coverage and authorization status to the concerned operational team to guide appropriate service provision.
• Escalate unresolved eligibility or coverage concerns before services are rendered whenever practicable.

2. Claims Collation & Documentation

• Collect and organize all documents required for claim submission, including patient information, eligibility records, authorizations, clinical documentation, diagnostic results, prescriptions, service records, billing statements, claims forms, and other supporting documents.
• Coordinate with Medical Records, Clinic Operations, Pharmacy, Laboratory, Radiology, physicians, and other departments to obtain missing or corrected documentation.
• Maintain organized electronic and physical claim files with appropriate tracking and document control.

3. Pre-Claim Validation

• Review claims prior to submission for completeness, consistency, eligibility, authorization, service coverage, documentation, and billing accuracy.
• Validate that services being claimed correspond with actual services rendered and available supporting records.
• Identify incomplete, inconsistent, or potentially non-compliant claims and coordinate correction before submission.
• Help minimize claim denials, returns, and payment delays through effective pre-submission validation.

4. Claims Processing & Submission

• Prepare, encode, and submit claims through the appropriate HMO, PhilHealth, insurer, corporate, or third-party payor platform or process.
• Ensure claims are submitted accurately and within required filing periods.
• Maintain records of submission dates, claim numbers, amounts claimed, supporting documents, and acknowledgment or reference numbers.
• Monitor claims from initial submission through processing and final disposition.

5. Claims Monitoring & Follow-Up

• Regularly monitor the status of outstanding claims.
• Follow up with HMOs, PhilHealth, insurers, and other third-party payors regarding pending, returned, denied, approved, or unpaid claims.
• Maintain an updated claims tracker reflecting the current status and required next action for each claim.
• Identify claims approaching filing, compliance, or appeal deadlines and initiate appropriate action.
• Escalate significantly delayed or problematic claims to management.

6. Returned, Denied & Deficient Claims

• Review reasons for returned, denied, reduced, or suspended claims.
• Coordinate with concerned departments to correct deficiencies and secure additional documentation.
• Facilitate resubmission, reconsideration, reconciliation, or other appropriate action within applicable deadlines.
• Analyze recurring reasons for claims rejection or delay and recommend process improvements to reduce preventable revenue leakage.

7. Accounts Receivable Endorsement & Reconciliation

• Endorse successfully processed, approved, or billable claims to Accounting with complete supporting documentation for proper accounts receivable booking.
• Ensure Accounting receives the appropriate payor, patient, claim reference, service date, approved amount, and other information necessary for accurate recording.
• Coordinate with Accounting regarding discrepancies between claimed, approved, recorded, and paid amounts.
• Assist in reconciling outstanding claims against payments and remittance information received from third-party payors.
• Coordinate unresolved or aged receivables with the appropriate Finance and Accounting personnel.

8. Coordination with Operations

• Provide timely information to Clinic Operations and other service departments regarding patient eligibility, authorized services, coverage limitations, co-payments, and other payor requirements.
• Coordinate with operational teams to prevent provision of services outside approved coverage unless appropriately authorized or arranged with the patient.
• Communicate changes in HMO, PhilHealth, or third-party payor requirements that may affect registration, service provision, documentation, or billing.
• Support the development of efficient workflows connecting patient registration, eligibility verification, service provision, documentation, claims processing, and collection.

9. HMO, PhilHealth & Third-Party Payor Coordination

• Serve as an operational point of contact for claims-related communications with HMOs, PhilHealth, insurers, corporate accounts, and other third-party payors.
• Maintain updated information regarding claims requirements, submission procedures, benefit rules, contact persons, portals, and processing requirements.
• Coordinate resolution of claim discrepancies, documentation requests, and payment concerns.
• Maintain professional working relationships with third-party payor representatives.

10. Claims Reporting & Revenue Cycle Support

• Prepare periodic reports on claims submitted, approved, denied, returned, pending, paid, and outstanding.
• Monitor claims aging and identify accounts requiring urgent follow-up.
• Report significant claims issues, reimbursement delays, recurring deficiencies, and potential revenue risks to management.
• Provide claims data that may support management decisions, financial forecasting, and process improvement.

11. Compliance & Confidentiality

• Ensure claims processing complies with applicable TeleCure policies, contractual requirements, PhilHealth and HMO requirements, and relevant healthcare and data privacy regulations.
• Maintain confidentiality and security of patient, financial, and claims information.
• Cooperate with internal audits, external audits, claims validation, and payor reviews.
• Maintain sufficient documentation and audit trails for claims transactions.

QUALIFICATIONS & REQUIREMENTS

Education: Bachelor's degree in Business Administration, Healthcare Administration, Accounting, Finance, Medical Records, or another relevant field.

Experience: Experience in HMO, PhilHealth, healthcare billing, claims processing, revenue cycle management, healthcare administration, and the use of ICD-10 is preferred.

Technical Skills:

• Familiarity with healthcare claims documentation, benefit verification, billing, and accounts receivable processes.
• Strong attention to detail and ability to identify documentation and billing discrepancies.
• Strong organizational and follow-up skills, particularly in managing multiple pending claims and deadlines.
• Good written and verbal communication skills for coordination with patients, internal departments, and third-party payors.
• Proficiency with spreadsheets, electronic medical records, claims portals, and other healthcare information systems is an advantage.
• High level of integrity and confidentiality in handling patient and financial information.

BENEFITS & PERKS

• Health & Wellness: Free General Practitioner consultations, Annual Physical Exams, flu vaccinations, and exclusive discounts on medical and diagnostic services for employees and their immediate family.
• Pharmacy Discounts: Enjoy exclusive employee discounts on groceries, generic medicines, and branded medicines at TeleCure Pharmacy.
• Allowances & Statutory Benefits: Receive a regular monthly rice subsidy and 13th-month pay in accordance with applicable law and company policy.
• Paid Time Off: Enjoy paid Vacation Leave, with applicable unused credits convertible to cash at year-end, Sick Leave, and paid Birthday Leave.
• Career Development: Grow professionally through company-sponsored seminars, training opportunities, and one-on-one career coaching sessions with the CEO.

EQUAL OPPORTUNITY

TeleCure Corporation is an equal opportunity employer committed to maintaining a professional, respectful, and inclusive workplace where employees are supported in their professional growth and development.