Claims Processor
2 weeks ago
Job Purpose
This job is responsible for the review, analysis and/or adjudication of claims incurred by eligible members of the Client's Network to ensure that they are according to respective benefits plan, policies and standards
and maintains the records system for these claims.
Duties and Responsibilities- Ensures accurate review of claims documents like LOA, hospital bills/SOA, concurrent review form, physician's report, original OR for use in processing claims.
- Checks on completeness of received claims documents
- Reviews and matches the endorsed document against the actual encoded data in the system.
- Reviews/evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards.
- Reviews, evaluates. checks and/or adjudicates claims against ABC, CQS and utilization and existing company policies and procedures for coverage and effectivity of plan
- Accurately evaluates and processes Outpatient and In-patient claim reimbursement and non-reimbursement, received from various providers and meet the required quota.
- Responsible for assigning RUV based on surgical procedure done.
- Responsible for computation of incremental cost and Philhealth.
- Verifies if the account has adequate funds to cover claim or payment to the provider is released.
- Coordinates needs and requirements with other concerned departments to facilitate processing and minimize errors
- Verifies from Hospital doctor in case of dispute regarding claims/checks as the case maybe
- Generates correct SOAs on medical bills that are non-coverable
- Reconcile EWB versus payment / accounts, prepare manual SOA
- Process advance SOA based on suretyship given by Billing Collections.
- Ensures provision of quality customer service
- Maintains good relationships with providers by making regular visits and ensuring timely payment of medical bills, in coordination with other departments.
- Handles inquiries of clients, members and agents regarding application for claims, including handling complaints.
- Undertakes Administrative Responsibilities to ensure proper filing of claims documentation and booking them.
- Makes accounting entries to book claims transactions
- Logs and files documents and transmittals of released comments
- Turns over all processed claims transactions to the Records Room
- Maintains computerized system used in processing claims thru timely, accurate capturing, recording and dissemination of claims information
- Prepares Management Reports on claims
- Graduate of any 4 year course.
- 1-year experience in Claims processing, adjudication and knowing medical technologies and terms
- Good grasp of basic claims procedures
- Knowledge of medical terminologies, comprehension of frequently used medical terms as well as medical conditions and procedures
#J-18808-Ljbffr
-
Claims Processor
2 weeks ago
Makati City, National Capital Region, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company's policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of claims...
-
Claims Processor
2 weeks ago
Makati City, National Capital Region, Philippines SLI Consulting Inc. Full timeJob Description:Identify and implement new claims procedures.Identify, evaluate, and resolve claims in accordance with company standards.Analyze medical claims to ensure payments are accurate.Verify documents and coordinate health care coverage for patients, including eligibility of benefits.Analyze medical records to identify pre-existing conditions or...
-
Claims Evaluator
2 weeks ago
Makati City, National Capital Region, Philippines Prudential Guarantee and Assurance, Inc. Full timeReviews all claims documents and relates it to the insurance policy for complianceTasked to inspect the damages sustained by the vehicles being claimed, canvass the necessary parts and make recommendations on the most accurate amount of repair that can be approved for the claims filed.Tasked to scan and evaluate bodily injury claims filed under the motorcar...
-
Office Staff
2 weeks ago
Makati City, National Capital Region, Philippines LIFT OFF CONSULTING INC Full timeFOR OFFICE STAFF POSITIONS:WE NEED Claims Processor Reimbursement Staff Filing Clerk Membership OfficerMINIMUM QUALIFICATION:College graduate of any 4 yrsWORK LOCATION:Makati City
-
Loans Processor
2 weeks ago
Quezon City, National Capital Region, Philippines CEPAT KREDIT FINANCING INC. Full timePerforms administrative functions such as facilitate the releasing of loan check and ensuring compliance of the borrower to loan documents or requirements.Key Responsibilities: Informs the client regarding loan charges such as monthly amortization, deductions, penalties, net proceeds and documentation requirements prior to release of loan. Ensures that...
-
Treasury Operation Team Lead-AP
2 weeks ago
Quezon City, National Capital Region, Philippines Manulife Insurance Malaysia Full timeTreasury Operation Team Lead-AP page is loaded Treasury Operation Team Lead-AP Apply locations Quezon City time type Full time posted on Posted Yesterday job requisition id JR We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental...
-
Claim Processor or CSA
2 weeks ago
ayala makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed.here`s also the job qualificationFor Claims ProcessorCollege graduateWith experience at least 3-6 months of experience in processing medical claims benefits for local or international account or other...
-
Claim Processor or CSA
2 months ago
ayala makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed. here`s also the job qualification For Claims Processor College graduate With experience at least 3-6 months of experience in processing medical claims benefits for local or international account or...
-
Claim Processor or CSA
4 weeks ago
ayala makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed. here`s also the job qualification For Claims Processor College graduate With experience at least 3-6 months of experience in processing medical claims benefits for local or international account or...
-
Claim Processor or CSA
4 weeks ago
ayala makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed. here`s also the job qualification For Claims Processor College graduate With experience at least 3-6 months of experience in processing medical claims benefits for local or international account or...
-
Claim Processor or CSA
2 months ago
ayala makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed. here`s also the job qualification For Claims Processor College graduate With experience at least 3-6 months of experience in processing medical claims benefits for local or international account or...
-
Claim Processor or CSA
2 months ago
Makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed.here`s also the job qualificationFor Claims ProcessorCollege graduateWith experience at least 3-6 months of experience in processing medical claims benefits for local or international account or other...
-
Claim Processor or CSA
4 weeks ago
Makati, Philippines TASQ STAFFING SOLUTIONS Full timeGood day, We are looking for a candidate to work on site in ayala makati for Claim processor. the candidate must be willing to render overtime when needed.here`s also the job qualificationFor Claims ProcessorCollege graduateWith experience at least 3-6 months of experience in processing medical claims benefits for local or international account or other...
-
Claims Processor
4 weeks ago
Makati, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company’s policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of...
-
Claims Processor
2 months ago
Makati, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company’s policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of...
-
Claims Processor
2 months ago
Makati, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company’s policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of...
-
Claims Processor
4 weeks ago
Makati, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company’s policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of...
-
Claims Processor
4 weeks ago
Makati, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company’s policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of...
-
Claims Processor
2 months ago
Makati, Philippines Fortune Life Insurance Company Full timeHandle processing of claims within required turnaround time. Also, to handle in-process claims, approved claims, denied claims and claims with requirements based on the Company’s policies and procedures. Monitors the status of claims and update the Claims Registry accurately. Receive and log received claims documents and prepares the documentation of...
-
Claims Processor
2 months ago
Makati, Philippines SLI Consulting Inc. Full timeJob Description:Identify and implement new claims procedures.Identify, evaluate, and resolve claims in accordance with company standards.Analyze medical claims to ensure payments are accurate.Verify documents and coordinate health care coverage for patients, including eligibility of benefits.Analyze medical records to identify pre-existing conditions or...
-
Claims Processor
2 months ago
Makati, Philippines SLI Consulting Inc. Full timeJob Description: Identify and implement new claims procedures. Identify, evaluate, and resolve claims in accordance with company standards. Analyze medical claims to ensure payments are accurate. Verify documents and coordinate health care coverage for patients, including eligibility of benefits. Analyze medical records to identify pre-existing...
-
Claims Processor
2 months ago
Makati, Philippines SLI Consulting Inc. Full timeJob Description: Identify and implement new claims procedures. Identify, evaluate, and resolve claims in accordance with company standards. Analyze medical claims to ensure payments are accurate. Verify documents and coordinate health care coverage for patients, including eligibility of benefits. Analyze medical records to identify pre-existing...
-
Claims Evaluator
2 months ago
Makati City, Philippines Prudential Guarantee and Assurance, Inc. Full time-Reviews all claims documents and relates it to the insurance policy for compliance -Tasked to inspect the damages sustained by the vehicles being claimed, canvass the necessary parts and make recommendations on the most accurate amount of repair that can be approved for the claims filed. -Tasked to scan and evaluate bodily injury claims filed under the...
-
Claims Processor
3 weeks ago
Angeles City, Philippines SOURCETECH SOLUTIONS INC. Full timeEssential Duties and Responsibilities: • Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines. • Verify member eligibility and benefits coverage for submitted claims. • Evaluate medical documentation to assess the appropriateness of services rendered and coding...
-
Claims Processor
3 weeks ago
Angeles City, Philippines SOURCETECH SOLUTIONS INC. Full timeEssential Duties and Responsibilities: • Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines. • Verify member eligibility and benefits coverage for submitted claims. • Evaluate medical documentation to assess the appropriateness of services rendered and coding...
-
Claims Evaluator
2 months ago
Makati City, Philippines Prudential Guarantee and Assurance, Inc. Full time-Reviews all claims documents and relates it to the insurance policy for compliance -Tasked to inspect the damages sustained by the vehicles being claimed, canvass the necessary parts and make recommendations on the most accurate amount of repair that can be approved for the claims filed. -Tasked to scan and evaluate bodily injury claims filed under the...