
Claims Specialist
3 weeks ago
On-site - Makati Fresh Graduate/Student Bachelor Full-time
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Job Description Government Mandated Benefits Insurance Health & Wellness Professional DevelopmentJob Training
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- Responsible for analyzing, adjudicating, auditing, and processing of claims (In-Patient, Outpatient Hospital Bills and Professional Fees) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements)
- Analyze claim submissions to verify policyholder and provider information, ensuring accuracy and completeness against submitted documentation.
- Liaise with clients, insurance agents, beneficiaries, healthcare providers, and other departments to gather information, resolve issues, and provide updates on claim status.
- Prepare and maintain accurate records of all claim activities and policy information, often using specialized database systems.
- Determine policy coverage, calculate the appropriate claim amounts, and process payments or other reimbursements.
- Ensure all claim processing activities adhere to company policies, procedures, and relevant state and federal regulations.
- Investigate and resolve any discrepancies or issues that arise during the claim process.
- Graduate of any 4-year course.
- Fresh graduates are welcome to apply.
Recruitment Supervisor SPD Jobs Incorporated
Active within three days
Working LocationOmnis Prosperity Tower. Omnis Prosperity Tower, 379 Sen. Gil J. Puyat Ave, Makati City, Metro Manila, Philippines
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