Healthcare Claims Representative | Day 1 HMO
18 hours ago
ROLE AND RESPONSIBILITIES Responsible in triaging assigned client claims and make determinations on opening cases for medical record review, in addition, the team also does a thorough review of medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate follow-up. Once the claim information is organized this will go to the clinical and coding teams for review of medical records. JOB QUALIFICATIONS Graduate of any 4 Year Course With a minimum of 2 years experience in handling Healthcare Claims Processing, Investigations/ Research in a BPO setting or environment Note: Experience in a BPO Healthcare Account Required Must be willing to report onsite in Makati Must have customer service, communication & computer skills WHAT WE OFFER Market Competitive Pay Levels Retirement Plan Medical Plan (HMO) from Day 1 of employment Dental, Medical, and Optical Reimbursements Life and Disability Insurance Paid Time-Off Benefits Sick Leave Conversion Tuition Fee Reimbursement Employee Assistance Program (EAP) Annual Performance Based Merit Increases Employee Recognition Training and Staff Development Employee Referral Program Employee Volunteerism Opportunity All Mandatory Statutory Benefits WHO WE ARE Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone. We’re a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center. As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world. We’re a diverse team with operations across North America, South America, Europe, Asia Pacific and the Middle East. This includes our over 25,000 employees in the Philippines. Elevate your career with a leading health care company while improving lives. Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together #J-18808-Ljbffr
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BPO Healthcare Claims Processor – Day 1 HMO
19 hours ago
Makati, Philippines Optum, a UnitedHealth Group Company Full timeROLE AND RESPONSIBILITIES Responsible in triaging assigned client claims and make determinations on opening cases for medical record review, in addition, the team also does a thorough review of medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate follow-up....
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Healthcare Claims Representative
2 days ago
Makati City, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time ₱900,000 - ₱1,200,000 per yearROLE AND RESPONSIBILITIESResponsible in triaging assigned client claims and make determinations on opening cases for medical record review, in addition, the team also does a thorough review of medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate...
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BPO Healthcare Claims Representative
1 week ago
Makati City, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time ₱300,000 - ₱600,000 per yearROLE AND RESPONSIBILITIESResponsible in triaging assigned client claims and make determinations on opening cases for medical record review, in addition, the team also does a thorough review of medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate...
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Claims Specialist
1 week ago
Makati, Philippines Dempsey Resource Management Inc. Full timeResponsibilities 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...
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Claims Processor
1 week ago
Makati, Philippines Dempsey Resource Management Inc. Full timeReview 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. Bachelor’s...
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Customer Service
1 week ago
Makati City, National Capital Region, Philippines NEW ERA PLACEMENT AGENCY CO. Full time ₱240,000 - ₱384,000 per yearReady to take your BPO career to the next level? This is your chance to join a dynamic and rewarding workplaceRole: Customer Care RepresentativeAccount: Healthcare AccountStart Date: October 27, 2025WORK CONDITIONS:Work Location: Bonifacio Global City, Taguig City 1634Work Set-Up: Hybrid (2-3 days onsite)Work Schedule: Fixed Night Shift w/ Fixed Weekends...
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Makati City, National Capital Region, Philippines Emapta Full time $104,000 - $130,878 per yearRedefining Legal Support for the Healthcare Space Our client is a U.S.-based legal and compliance services company specializing in Independent Dispute Resolution (IDR) under the No Surprises Act and state-level surprise billing laws. They partner with providers, facilities, and legal stakeholders to streamline the dispute process and deliver transparent,...
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Customer Service Representative
19 hours ago
Makati, Philippines Nezda Technologies, Inc. Full timeAbout the role We are is seeking a dedicated and experienced Customer Service Representative to join our team in Makati City, Metro Manila. This is a full-time role, responsible for providing high-quality customer service and claims handling for our healthcare clients. Candidates must be available to work in graveyard shifts as required by business...
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Makati, Philippines Emapta Full timeA career in care that cares for you too. In the demanding world of healthcare support, balance is rare - but not here. This is where dedicated professionals thrive without burning out. Here, your expertise in healthcare claims helps people get the care they deserve - while you enjoy the self care you also deserve with ample time for yourself and your family....
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Makati, Philippines Optum, a UnitedHealth Group Company Full timeROLE AND RESPONSIBILITIES: You will respond to customer service inquiries and issues by identifying the topic and type of assistance the customer needs. This may include, among others, inquiries or concerns on their benefits, eligibility and claims. You will guide and educate the customer about the fundamentals and benefits of consumer- driven health care...
