Medical Coding (Non-Voice / AUS Shift)

QBE Group Shared Services Centre; Cebu City; On-site; PHP 600,000 - 900,000; Full time

Job summary

QBE Group Shared Services Centre in Cebu City is seeking a Full-time Claims Specialist to assess policy coverage, investigate, evaluate, and negotiate claims to resolution. You will maintain knowledge of insurance guidelines, process incoming claims, set reserves, and respond to client requests with professionalism.

The role emphasizes accuracy, compliance, and collaboration with stakeholders, including handling suspicious claims and ensuring timely communication.

Qualifications

• Must have strong analytical and problem-solving skills.
• Experience with claims processing and settlements.
• Knowledge of insurance guidelines and policy changes.
• Ability to communicate clearly with stakeholders and clients.

Responsibilities

• Maintain current knowledge of insurance guidelines and policy changes.
• Resolve non-compliant issues and escalates when necessary.
• Maintain good client relationships and respond to client requests promptly.
• Process incoming insurance claims and determine coverage.
• Set reserves, authorise payments, and settle claims efficiently.
• Identify and report suspicious or fraudulent claims.
• Share information with stakeholders while considering confidentiality guidelines.
• Ensure compliance with accreditation levels and policies.
• Provide clear and timely communication with all stakeholders.

Skills

Analytical Thinking

Claims Administration

Claims Processing

Communication

Customer Service

Risk Management

Education

Tertiary Degree

Job description

Primary Details

Time Type: Full timeWorker Type: EmployeeThe purpose of this role is to deliver claims service by accurately assessing policy coverage, investigating, evaluating, and negotiating assigned cases to resolution.

Responsibilities:

• Maintain current knowledge of insurance guidelines and policy changes.
• Resolve non-compliant issues and escalates when necessary.
• Maintain good client relationships and respond to client requests promptly.
• Process incoming insurance claims and determine coverage.
• Set reserves, authorise payments, and settle claims efficiently.
• Identify and report suspicious or fraudulent claims.
• Share information with stakeholders while considering confidentiality guidelines.
• Ensure compliance with accreditation levels and policies.
• Provide clear and timely communication with all stakeholders.

Work Experience:

Necessary Work Experience includes:

• Some relevant work experience in motor claims.

Preferred Work Experience includes:

• Some experience in insurance

Qualifications:

Preferred Qualifications include:

• Tertiary Degree or equivalent combination of education and work experience.

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.

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.

US Only - Travel Frequency:

Occasional (approximately 5-10 trips annually)

US Only - Physical Demands:

General office jobs:

• Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions.
• Must have the ability to remain in a stationary position for extended periods of time.
• Must be able to operate basic office equipment including telephone, headset and computer.
• Incumbent must be able to lift basic office equipment up to 20 lbs.

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.