Medical Reimbursement Associate

Rayomar Management, Inc.; Philippines; On-site; PHP 260,000 - 380,000; Full time

Job summary

Rayomar Insurance Business Agencies, Inc. partners with Rayomar Management Inc. to deliver health, insurance, and claims services across the Philippines. The role handles end-to-end medical, PEME, and life reimbursement claims for members and providers.

Candidates should have a Bachelor's degree and at least one year in healthcare claims or related field; you will review documents, coordinate with stakeholders, and ensure timely processing and compliance.

Qualifications

• Bachelor's degree in Nursing, Business Management, Finance, or any related field.
• At least one year of relevant work experience in healthcare claims, reimbursement processing, insurance, or a related field.

Responsibilities

• Process end-to-end medical, PEME, and life reimbursement claims.
• Review and validate claim documents for completeness, accuracy, and eligibility.
• Coordinate with members, healthcare providers, insurance companies, and internal teams to resolve claim-related concerns.
• Monitor claim status and ensure timely processing and reimbursement.
• Maintain accurate reimbursement records, logs, and databases.
• Prepare and submit daily, periodic, and summary reimbursement and claims reports.
• Update reimbursement reports and coordinate with service providers to reconcile utilization records.
• Provide reimbursement status updates to stakeholders and welfare officers.
• Ensure compliance with company policies, insurance guidelines, and regulatory requirements.
• Escalate complex claims or issues to the appropriate personnel when necessary.
• Support process improvement initiatives to enhance claims efficiency and customer satisfaction.
• Perform other related duties as assigned.

Education

Bachelor's degree in Nursing, Business Management, Finance, or any related field

Job description

Rayomar Insurance Business Agencies, Inc. is a proud member of Rayomar Management Inc.’s group of companies. Rayomar, one of the country’s progressive investment and management entity since 1982 , has operation and ownership of several companies involved in shipping, crewing, logistics, freight forwarding and international trading. Strongly believing in the protection and well‑being of it’s employees and their families whether at home or wherever they maybe around the globe, it established Rayomar Insurance Business Agencies (RIB) in 2004.

With a lot of companies expanding and diversifying in the country at this time, Rayomar Insurance in 2009, went beyond the group and offered it’s insurance, safety, and health management products to the corporate public. Foremost of this is it’s health programs, giving access to hundreds of accredited hospitals, clinics, wellness centers, and by specialist doctors in the country.

JOB RESPONSIBILITIES:

1. Process end-to-end medical, PEME, and life reimbursement claims.

2. Review and validate claim documents for completeness, accuracy, and eligibility.

3. Coordinate with members, healthcare providers, insurance companies, and internal teams to resolve claim-related concerns.

4. Monitor claim status and ensure timely processing and reimbursement.

5. Maintain accurate reimbursement records, logs, and databases.

6. Prepare and submit daily, periodic, and summary reimbursement and claims reports.

7. Update reimbursement reports and coordinate with service providers to reconcile utilization records.

8. Provide reimbursement status updates to stakeholders and welfare officers.

9. Ensure compliance with company policies, insurance guidelines, and regulatory requirements.

10. Escalate complex claims or issues to the appropriate personnel when necessary.

11. Support process improvement initiatives to enhance claims efficiency and customer satisfaction.

12. Perform other related duties as assigned.

Qualifications:

• Bachelor's degree in Nursing, Business Management, Finance, or any related field.

• At least one (1) year of relevant work experience in healthcare claims, reimbursement processing, insurance, or a related field.