Back to Careers
Senior Claims Specialist (Makati)
Benefits
- Competitive rewards with 13th and 14th month pay
- Comprehensive health insurance including life insurance and accident insurance
- Retirement benefits
- Annual medical allowance to support wellness needs
- Generous leave entitlements: vacation leave, sick leave, and emergency leave
Duties and Responsibilities
- Checks availability and accuracy of claims details in MAS
- Makes necessary corrections of claims details
- Verifies unlisted claims in MAS with biller and Call Center
- Processes and analyze claims using the prescribed process and based on existing policy contract and guidelines
- Prepares transmittal of claims for payment
- Approves payment for claims within the authority limit
- Recommends approval of claims payment beyond authority limit
- Reconcile claims with providers/accounts
- Conduct UAT of system enhancements
- Provide analysis and findings on the UAT done
- Coordinate with ITG on the findings
- Answer inquiries via email or phone regarding status of claims or overdue payments within set turn-around time
- Documentation of medical claims disputes or complaints
- Resolution or escalation of claims disputes or complaints within the TAT
- Coordination with sales and other work units on claims or non-claims related customer concerns received via email or phone
- Reconciles statement of account (SOA) sent by providers
- Coordinate with concerned departments on the items subject of reconciliation
Qualifications
- College graduates with a degree in any medical or business-related discipline
- At least two (2) years’ experience in medical or life claims processing
- Preferably passed Life Office Management Association (LOMA) courses
Senior Claims Specialist
Operations
Hybrid (3x onsite, 2x Work from Home/Anywhere every week)
Petron Megaplaza, Buendia, Makati City
Apply for this Position
1
Applicant Details
Next: Educational Background
1
Applicant Details2
Educational Background3
Employment History