PhilHealth Claims Specialist

Peoples Pharma Equipment and Supplies Inc.; Balasan; On-site; PHP 120,000 - 180,000; Full time

Job summary

Peoples Pharma Equipment and Supplies Inc. is seeking an Admin Staff – PhilHealth Claims to accurately prepare, file, monitor, and reconcile PhilHealth claims to ensure timely reimbursement and compliance. The role supports cash flow and regulatory compliance within a healthcare facility.

The candidate should have 1–2 years in PhilHealth claims processing, be detail-oriented, and proficient with MS Excel/Word. Hospital or dialysis setting experience is an advantage.

Qualifications

• Graduate of any business, healthcare, or allied course.
• With at least 1–2 years experience in PhilHealth claims processing.
• Experience in hospital or dialysis center setting is an advantage.
• Knowledgeable in PhilHealth policies, Z-benefits, and claims guidelines.
• Detail-oriented and highly organized.
• Computer literate (MS Excel, Word, email systems)

Responsibilities

• Prepare, process, and submit PhilHealth claims and required documents
• Ensure completeness and accuracy of claim forms, attachments, and supporting records
• Monitor claim status, follow up reimbursements, and resolve denied or returned claims
• Coordinate with nurses, physicians, and billing staff for necessary documentation
• Maintain organized records of filed, paid, pending, and denied claims
• Ensure compliance with PhilHealth rules, circulars, and accreditation requirements
• Assist in audits, inspections, and PhilHealth accreditation activities
• Generate claims reports and summaries for management review
• Safeguard confidentiality of patient and billing information

Skills

Attention to detail

Time management

Coordination

Communication

Analytical thinking

Education

Business/Healthcare related degree

Tools

MS Excel

MS Word

Email systems

Job description

Peoples Pharma Equipment and Supplies Inc. is seeking an Admin Staff – PhilHealth Claims to accurately prepare, file, monitor, and reconcile PhilHealth claims to ensure timely reimbursement and compliance. The role supports cash flow and regulatory compliance within a healthcare facility.

The candidate should have 1–2 years in PhilHealth claims processing, be detail-oriented, and proficient with MS Excel/Word. Hospital or dialysis setting experience is an advantage.