Service Officer

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

In this position you will....

be involved in medical claims by determining insurance coverage; examining and resolving medical claims; complete documentation; maintaining quality customer services and ensuring legal compliance.

You will be responsible for…

• Studying provisions of policy or certificate.
• Initiating or conducting investigation of questionable claims.
• Completing forms, reports, logs, and records in relation to claims or services.
• Maintaining quality customer services by following customer service practices; responding to customer inquiries and providing timely updates to the customer.
• Preparing reports by collecting, analyzing, and summarizing information.
• 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.

For you to be successful…

We expect you to be able to demonstrate the following key competencies

• Communication
  • Able to communicate with the customer effectively using different channels (voice, email, chat).
  • Demonstrates active listening and promotes 2-way communication during interaction with the customer.
• Collaborative
  • Works collaboratively and cooperatively with insurer and other departments (eg BI) to achieve solutions with the best possible results to all parties involved.
• Customer focus
  • Putting the customers’ needs first and responds quickly to ideas and requests.
  • Open to feedback and uses available data and information to further improve internal processes.
• Adaptable
  • Quick to adapt and flexible in responding to changes specially on operational matters.
  • Able to manage multiple requirements positively and proactively to reach required goals.
• Creative
  • Able to leverage new innovations to achieve required goals.
  • Test out new ideas or approaches to achieve best solution.

You will require the following qualifications and skills

• 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.