Sr. Health Claims Analyst

3 days ago

Makati City, National Capital Region, Philippines Manulife Full time

The opportunity

This Sr. Health Claims Analyst is responsible for the overall review, assessment, and decision of claims.

Responsibilities:

  • Determine eligible benefits based on documents submitted and policy provisions.
  • Adjudicate claims and determine corresponding recommendation or decision within prescribed approval limits and within the defined turnaround time.
  • Review recommendation and decision referred by the Third-Party Administrator (TPA) for approval.
  • Ensure accurate benefit payouts and checking are being done in accordance with the policy details, laws, and regulations.
  • Assist the Claims Manager in resolving claims-related issues and/or concerns.
  • Discuss claim decisions with complaints team, TPA, distributors and/or customers whenever necessary.
  • Assist junior adjudicators with complex claims beyond their authorities.
  • Escalate possible fraudulent claims to the Team Lead and recommend appropriate action.
  • Maintain accurate records of claims, communications, and resolutions in the claims management system.
  • Actively participate in and contribute to projects and initiatives.

How will you create impact?

The role will report to the Health Claims Sr. Manager.

What motivates you?

  • You obsess about customers, listen, engage and act for their benefit.
  • You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
  • You thrive in teams and enjoy getting things done together.
  • You take ownership and build solutions, focusing on what matters.
  • You do what is right, work with integrity and speak up.
  • You share your humanity, helping us build a diverse and inclusive work environment for everyone.

What we are looking for

  • At least three (3) years' experience in life and health claims processing, insurance, or a related field.
  • Bachelor's degree in healthcare administration, business, or a related field is preferred.
  • With industry certifications or exams passed (FLMI, etc.).

What can we offer you?

  • A competitive salary and benefits packages.
  • A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
  • A focus on growing your career path with us.
  • Flexible work policies and strong work-life balance.
  • Professional development and leadership opportunities.

Our commitment to you

  • Values-first culture
    We lead with our Values every day and bring them to life together.

  • Boundless opportunity
    We create opportunities to learn and grow at every stage of your career.

  • Continuous innovation
    We invite you to help redefine the future of financial services.

  • Delivering the promise of Diversity, Equity and Inclusion
    We foster an inclusive workplace where everyone thrives.

  • Championing Corporate Citizenship
    We build a business that benefits all stakeholders and has a positive social and environmental impact.

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit our story.

Manulife is an Equal Opportunity Employer

At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact recruitment@manulife.com.

Working Arrangement

Hybrid

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