Claims Supervisor

4 weeks ago


Cebu City, Central Visayas, Philippines MAESTRO HOLDINGS Full time

QUALIFICATIONS

  • 4 year graduate of any course

  • With experience as Claims Processor (Preferably Supervisory level)

  • Willing to work in Makati

  • Can start ASAP

DUTIES AND RESPONSIBILITIES:

1. CLAIMS PROCESSING

  • Ensures accurate review of claims document like LOA, hospital bills/SOA, concurrent review form, physician's report, original OR for use in processing claims.

2. CLAIMS REVIEW/ EVALUATION/ ADJUDICATION

  • Reviews/evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards

3. CLAIMS APPROVAL

  • Approves claims according to limits of authority.

4. CUSTOMER SERVICE

  • Ensures provision of quality customer service

  • Maintains good relationships with providers by making regular visits and ensuring timely payment of medical bills, in coordination with other departments.

  • Handles inquiries of clients, members and agents regarding application for claims, including handling complaints.

5. ADMINISTRATIVE RESPONSIBILITIES

  • Undertakes Administrative Responsibilities to ensures proper filing of claims documentation and booking them

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