Claims Benefit Manager

2 weeks ago

Pasig, Philippines Hive Health Full time

Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we’re on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we’d love to meet you About the Role As the Claims Benefit Manager, you will lead Hive’s medical adjudication operations to ensure claims are reviewed accurately, efficiently, and in alignment with policies and regulatory standards. You’ll oversee a team of medical liaisons responsible for evaluating claims, managing provider coordination, and maintaining quality and compliance across the process. This is both a strategic and hands‑on leadership role. You’ll drive continuous process improvements, coordinate across departments such as Adjudication, Legal, and Provider Partnerships, and play a key part in shaping how Hive delivers fast, fair, and reliable claims experiences to its members and providers. Responsibilities Lead and manage the medical liaisons team to meet accuracy, quality, and service targets Oversee daily adjudication operations to ensure claims are processed efficiently and in compliance with policy guidelines Conduct audits to ensure claims accuracy, completeness, and consistency with internal standards Identify potential cases of fraud, waste, or abuse (FWA) and coordinate investigations with Legal and Compliance Work cross‑functionally with Claims, Provider Partnerships and Healthcare Services to address recurring operational issues Monitor key metrics such as turnaround time, quality scores, and error rates, and implement corrective measures as needed Drive continuous process improvements to enhance provider and member experience in the claims process Qualifications Bachelor’s degree in nursing, healthcare management, business, or a related field At least 5 years of experience in operations, healthcare administration, or team management Strong analytical and problem‑solving skills, with a focus on process improvement Experience leading teams and driving performance in fast‑paced environments Comfortable working with data, reports, and digital systems to track metrics and quality outcomes Excellent communication and stakeholder management skills across both medical and non‑medical teams Join our team as we revolutionalize healthcare in the Philippines—and beyond ✨ Day 1 benefits for full‑time employees – because we practice what we preach Enjoy comprehensive healthcare coverage for you and your dependent, and paid time off from the start.

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