Medical Claims Processor- Medical Coding

QBE Group Shared Services Centre; Taguig; On-site; PHP 420,000 - 640,000; Full time

Job summary

QBE Group Shared Services Centre in the Philippines seeks an experienced Medical/Injury Coding professional. You will review medical reports and hospital records to identify diagnoses and injuries and assign standardized codes in line with AIS or equivalent frameworks.

You will complete coding within SLA and regulatory timeframes, liaise with internal and external networks, and stay current with Motor Accident Authority guidelines. Strong English communication is required.

Qualifications

• Review and interpret medical reports, certificates, hospital records and clinical documentation to identify relevant diagnoses and injuries.
• Accurately assign standardized medical or injury codes (AIS or equivalent framework) in line with regulatory and internal guidelines.
• Complete initial, review and final coding within prescribed service level agreements and regulatory timeframes.
• Participate in meetings to share and develop strategy, knowledge and best practice.
• Ensure current knowledge and adherence to Motor Accident Authority legislation, government and Company guidelines.
• Liaise with internal and external network to obtain relevant information.
• Accumulate data to identify the type and severity of injuries sustained in motor vehicle accidents.

Responsibilities

• Review and interpret medical reports, certificates, hospital records, and clinical documentation to identify relevant diagnoses and injuries.
• Accurately assign standardized medical or injury codes (AIS or equivalent framework) in line with regulatory and internal guidelines.
• Complete initial, review and final coding within prescribed service level agreements and regulatory timeframes.
• Participate in all relevant meetings to share and develop strategy, knowledge and best practice.
• Ensure current knowledge and adherence to relevant Motor Accident Authority legislation, government and Company guidelines.
• Liaise with internal and external network to obtain relevant information.
• Accumulate data to identify the type and severity of injuries sustained in motor vehicle accidents.

Skills

Medical coding

AIS coding

Injury classification

Claims processing

Regulatory knowledge

English communication

Education

Graduates of medical allied courses (Nursing, Physical Therapy)

Job description

• Prioritizing complex cases under SLA pressure

Primary Details

Time Type: Full timeWorker Type: EmployeeMedical Coding, or Injury Coding, is a regulated and audit-exposed activity. Coding accuracy directly impacts claim outcomes, reserving, actuarial modelling, and regulatory reporting, requiring specialized skills and formal accreditation.

Primary Responsibilities

• Review and interpret medical reports, certificates, hospital records, and clinical documentation to identify relevant diagnoses and injuries
• Accurately assign standardized medical or injury codes (i.e AIS or equivalent framework) in line with regulatory and internal guidelines
• Complete initial, review and final coding within prescribed service level agreements and regulatory timeframes
• Participate in all relevant meetings in order to share and develop strategy, knowledge and best practice
• Ensure current knowledge and adherence to relevant Motor Accident Authority legislation, government and Company guidelines
• Liaise with internal and external network to obtain relevant information
• Accumulate data in order to identify the type and severity of injuries sustained in motor vehicle accidents

Required Education

• Graduates of medical allied courses preferably Nursing, Physical Therapy

Required Experience

• Insurance injury coding
• Trauma registries
• Health or claims environment using standardized injury classifications

Preferred Competencies/Skills

• Claims handling exposure
• Interpreting poorly structured and handwritten medical certificates
• Applying coding accuracy under scrutiny
• Prioritizing complex cases under SLA pressure
• Communicating coding outcomes to claims handlers and onshore stakeholders
• Excellent verbal and written communication skills (English)
• Preferably with Case Management Skills

Preferred Licenses/Certifications

• Abbreviated Injury Scale (AIS) certification is preferred but can also be taken as part of training.

US Only - Disclaimer

• To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.

Job Type

• Individual Contributor

Global Disclaimer

• The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee’s normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls.

Skills

Analytical Thinking, Claims Administration, Claims Processing, Claims Resolution, Communication, Critical Thinking, Customer Service, Customer Value Management, Financial Advising, Intentional collaboration, Managing performance, Process Compliance, Process Improvements, Risk Management, Stakeholder Management

Equal Employment Opportunity

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.