Medical Claims Specialist & Customer Advocate

Bolttech Device Protection Philippines, Inc.; Philippines; On-site; PHP 268,000 - 446,000; Full time

Job summary

Bolttech Device Protection Philippines, Inc. is seeking a claims professional to support medical claim processing and investigations. You will assess coverage, investigate questionable claims, and maintain timely communication with customers while ensuring accurate documentation and compliance.

The successful candidate will have at least two years in medical claims, strong analytical skills, and the ability to collaborate with insurers and internal teams to resolve cases efficiently.

Qualifications

• Minimum 2 years experience in handling medical claims.
• Ability to identify fraud claims.
• Good written and verbal communication, probing and listening skills.
• Collaborative and cooperative with other stakeholders to achieve solutions.
• Strong analytical skills, attention to detail and creative problem solver.
• Computer literacy in Word, Excel and PowerPoint.

Responsibilities

• Study provisions of policy or certificate to determine coverage.
• Initiate or conduct investigation of questionable claims.
• Complete forms, reports, logs, and records in relation to claims or services.
• Maintain quality customer services by following customer service practices; responding to customer inquiries and providing timely updates to the customer.
• Prepare reports by collecting, analyzing, and summarizing information.
• Determines covered medical insurance losses by studying provisions of policy or certificate.
• Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant or other sources.

Skills

Communication

Collaboration

Customer focus

Adaptability

Creativity

Analytical thinking

Tools

Microsoft Word

Excel

PowerPoint

Job description

Bolttech Device Protection Philippines, Inc. is seeking a claims professional to support medical claim processing and investigations. You will assess coverage, investigate questionable claims, and maintain timely communication with customers while ensuring accurate documentation and compliance.

The successful candidate will have at least two years in medical claims, strong analytical skills, and the ability to collaborate with insurers and internal teams to resolve cases efficiently.