Onsite Benefits Claims Adjudicator

RelianceUnited; Mandaluyong; On-site; PHP 279,000 - 502,000; Full time

Job summary

RelianceUnited in Mandaluyong is seeking a Claim Processor to ensure timely processing and adjudication of employee benefit claims, including FlexBen and HBA programs. You will review submissions, enter data, verify eligibility, and determine coverage while communicating issues to relevant departments.

The role requires a bachelor’s degree in health/medical fields, 2+ years in a related role, and experience in TPA/HMO/insurance.

Qualifications

• Bachelor's/college degree in health or medical allied fields such as Nursing or Pharmacy.
• At least 2 years of solid working experience in the related field.
• Experience in TPA, HMO, insurance, or insurance broker companies.
• Ability to work onsite and extend beyond company hours when needed.

Responsibilities

• Accurately captures claim data into the claims management system and maintains updated records of all claim transactions, communications, and outcomes.
• Analyze claims for completeness, accuracy, and compliance with the member’s benefit plan terms.
• Confirm member eligibility and verify that services or expenses are covered under their plan.
• Adjudicate and authorize payments or refer/escalate claims for further review.
• Investigate and resolve discrepancies by gathering information from members and other stakeholders.
• Inform employees on claim progress per SLA (e.g., pending, missing attachments, or credits).
• Respond to employees’ inquiries or complaints per SLA.

Education

Bachelor's/College Degree in health or medical allied fields (Nursing, Pharmacy, etc.)

Job description

RelianceUnited in Mandaluyong is seeking a Claim Processor to ensure timely processing and adjudication of employee benefit claims, including FlexBen and HBA programs. You will review submissions, enter data, verify eligibility, and determine coverage while communicating issues to relevant departments.

The role requires a bachelor’s degree in health/medical fields, 2+ years in a related role, and experience in TPA/HMO/insurance.