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HDSI: Claim Reconciliation Processor
1 month ago
Duties and Responsibilities:
- Conducts reconciliation of claims records from accredited hospitals and doctors within the agreed TAT to avoid suspensions of service.
- Research variances and closely coordinate reconciliation issues with other claims team (e.g., claim adjudicator, documentation), Provider Relations team, and/or Accounting team to resolve issues.
- Maintains logs used by the Recon team.
- Serve as a subject matter expert on claims reconciliation processes and procedures, providing guidance and support to colleagues as needed.
- Escalates issues/concerns on reconciliation process/requests to relevant departments.
Background and Qualifications:
- Candidates must possess at least a Bachelor's/College Degree in any field.
- Prior experience in claim reconciliation within the HMO or insurance industry is preferred.
- Ability to do on-site visits and extend beyond company operating hours when needed.
- Good communication and critical thinking skills.
- Knowledgeable of Google platforms such as but not limited to GDocs, GSheets, etc. and MS Office.
- Ability to handle multiple tasks, in a timely manner, on a continual basis under strict deadlines.
- Strong planning, organization, and follow-up skills.
- Proven ability to work independently and as a team member.
- Adheres consistently to the company values.
- Onsite work setup.
- Work Schedule: Mondays-Fridays, 8:00AM - 5:00PM.
- Assigned in Greenfield District, Mandaluyong City.
- Occasional travel to build partnerships with institutions and organizations may be expected, as well as attendance at relevant conferences and events.
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