Medical Claims Specialist — Customer Care & Investigation

EdirectInsure Group; Philippines; On-site; PHP 240,000 - 420,000; Full time

Job summary

EdirectInsure Group in the Philippines is seeking a claims professional to handle medical claims, determine coverage, and ensure accurate documentation with high service standards.

The role involves investigating questionable claims, communicating clearly with customers, and collaborating with insurers to reach timely, fair resolutions.

Strong analytical skills and attention to detail are essential to succeed in this position.

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 power point.

Responsibilities

• Be involved in medical claims by determining insurance coverage; examining and resolving medical claims; complete documentation; maintaining quality customer services and ensuring legal compliance.
• 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, initiating or conducting investigation of questionable claims.

Skills

Communication

Collaborative

Customer focus

Adaptable

Creative

Job description

EdirectInsure Group in the Philippines is seeking a claims professional to handle medical claims, determine coverage, and ensure accurate documentation with high service standards.

The role involves investigating questionable claims, communicating clearly with customers, and collaborating with insurers to reach timely, fair resolutions.

Strong analytical skills and attention to detail are essential to succeed in this position.