Medical Claims Analyst

4 weeks ago

Makati, Philippines Marine Benefits, Inc. Full time

Responsibilities

  • Assure accurate insurance claims adjudication in a timely manner.
  • Assure timely submission of invoices/claims utilization report.
  • Validate documents received as well as members' information to adjudicate the claims based on the submitted information.
  • Apply the Plan policy and its exclusion as well as underwriting guidelines to determine coverage for claims.
  • Deny claims according to SOB, exclusions, and policies.
  • Assure timely payment of invoices from providers and ensure all information and documents needed are accurate and complete.
  • Keep management aware of members' issues from providers to enhance operations and escalate to the higher-ups when necessary.
  • Coordinate with providers all Claims unpaid and do reconciliation.
  • Answer inquiries and handle complaints from providers.
Benefits
  • The country's best medical coverage for you and your family, with an annual limit of 100,000 USD (almost 6,000,000 PHP) per insured member.
  • Profit sharing (0-4 months extra salary per year performance-based—potential of 100K).
  • Flexible hybrid work set-up (1-10 days in the office per month).
  • Subsidized mobile plan (1,000 PHP).
  • Internet allowance (1,000 PHP).
  • 1-time 20,000 PHP allowance for home office set-up.
Qualifications
  • Bachelor's degree in nursing or related course.
  • Registered Nurse is an advantage.
  • Thorough knowledge of the claims process in medical insurance with a minimum of 1 year of relevant experience.
  • Structured and organized.
  • Good oral and written English communication skills.
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