Claims Specialist
1 week ago
Responsibilities Review and process medical claims submitted by members or healthcare providers. Check documents for completeness, including medical abstracts, itemized statements, and official receipts. Verify member eligibility, benefits coverage, and policy limits. Apply appropriate coding and benefits computation based on the member’s plan and HMO rules. Data Entry & Record Keeping: Encode claims data into the medical claims processing system; Maintain updated records of approved, denied, and pending claims; Document any adjustments, follow-ups, and discrepancies. Claims Evaluation: Evaluate claims against policy provisions and clinical guidelines; Detect potential fraud, abuse, or claim duplication; Coordinate with medical providers to validate unclear or questionable claims; Accurately calculate payable amounts, co-pays, and exclusions. Job Position: CLAIMS PROCESSOR/ANALYST Monthly Salary: PHP 18,000 Work Schedule: Monday to Friday Working Hours: 8:30 am to 5:30 pm Work Location: Makati Office Qualifications Educational Background: Bachelor’s degree in Business administration, Healthcare Management, Nursing, or a related field is preferred. A diploma in medical, healthcare, or business-related field may be considered. Experience: 1-2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries. Familiarity with medical billing and reimbursement processes. Experience working with HMO procedures and healthcare provider networks is a plus. Skills: Attention to details; Analytical thinking; Communication; Technical proficiency; Problem-solving. Proficiency in medical claims processing systems, Microsoft Excel, MS Word, and email platforms. Other Qualifications: Familiarity with ICD, CPT, and HCPCS codes and medical terminology. Knowledge of insurance guidelines, HMO processes, and regulatory compliance. Ability to multitask and work efficiently under time constraints. Excellent organizational and documentation skills. #J-18808-Ljbffr
-
Senior Claims Specialist
1 week ago
Makati, Philippines China Civil Engineering Constructions Corporation Full timeOverview Vacancy : Senior Claims Specialist Company : CCECC-HPRB-HNRBI JOINT VENTURE (PVT) LTD Project : Port Access Elevated Highway Project (PAEH Project) Type: Full Time Job Location: Sri Lanka We are hiring an experienced and highly competent Senior Claims Specialist for our PAEH Project. Handle contract claims, variations, and disputes effectively by...
-
Claims Helpdesk Specialist
1 week ago
Makati, Philippines AIA Hong Kong Full timeOverview At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone. It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030. And to get there, we...
-
Claims Specialist
1 week ago
Makati, Philippines Sundust Bros Corporation Full timeResponsibilities Evaluate and process insurance claims accurately and efficiently. Communicate with clients to gather necessary information and documentation. Investigate claims to determine validity and assess damages. Collaborate with underwriters and other departments to resolve issues. Maintain detailed records of claims activities and documentation....
-
Claims Specialist
1 week ago
Makati, Philippines North Asia Central Manpower Full timeOverview Provides administrative and clerical support for the claims process within an insurance company or similar organization. They handle incoming claim inquiries, manage claim files, prepare correspondence, and process payments. Their work ensures claims are processed efficiently and accurately, and they often interact with claimants, adjusters, and...
-
Claims Specialist
18 hours ago
Makati, Philippines SPD Jobs Incorporated Full timeOn-site - Makati Fresh Graduate/Student Bachelor Full-time Share Job Description Government Mandated Benefits Insurance Health & Wellness Professional Development Job Training Read More Responsible for analyzing, adjudicating, auditing, and processing of claims (In-Patient, Outpatient Hospital Bills and Professional Fees) according to set medical guidelines,...
-
Claims Specialist
1 week ago
Makati, Philippines Stronghold Insurance Company, Inc. Full timeOn-site - Makati No Exp Required Bachelor Full-time Job Description Government Mandated Benefits Review and process insurance claims efficiently and accurately. Investigate claim details and communicate with claimants and providers. Ensure compliance with policy guidelines and regulations. Maintain organized records and documentation. Provide exceptional...
-
Claims Officer
1 week ago
Makati, Philippines myGwork - LGBTQ+ Business Community Full timeJoin to apply for the Claims Officer role at myGwork - LGBTQ+ Business Community 1 day ago Be among the first 25 applicants Join to apply for the Claims Officer role at myGwork - LGBTQ+ Business Community Get AI-powered advice on this job and more exclusive features. This job is with AXA Investment Managers, an inclusive employer and a member of myGwork –...
-
Claims Helpdesk Specialist
7 days ago
Makati City, National Capital Region, Philippines AIA Australia Full time ₱900,000 - ₱1,200,000 per yearAt AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.It's about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.And to get there, we need ambitious...
-
Claims Specialist
1 week ago
Makati, Philippines AXA Full timeJob Responsibilities Acknowledge receipt of claim requests. Upload claim documents to the case in the health claims system. Validate claim details in the health claims system. Update claim status and notes in the health claims system. Update TPA file for endorsement to Claims Control Team. Adhere to service standards of processing administrative requests....
-
Claims Specialist
2 weeks ago
Makati, Philippines HR Network Inc. Full timeHelp ensure smooth and efficient processing of insurance claims. This role supports the claims team with documentation, investigation, and customer communication. -Input and organize claim information accurately in the system -Collect and file needed documents (e.g. receipts, medical reports) -Help review claims for errors or missing info -Assist with...