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Claims Specialist

1 week ago

Manila, National Capital Region, Philippines Asalus Corporation (IntelliCare) Full time
Job Description:

Duties & Responsibilities:

  • Conduct thorough investigations of questionable claims to ensure accurate and fair adjudication.
  • Utilize expertise to resolve claims by approving or denying, calculating benefits due, initiating payment, and preparing notice to members after case adjudication.
  • Maintain detailed documentation of medical claims by preparing worksheets for inpatient cases, data entry in the system, and keeping reports, logs, and records up-to-date.
  • Deliver high-quality services by following client service practices and responding to customer inquiries in a timely and professional manner.
  • Provide quality assurance by performing second layer checking of claims proposed by junior assessors to ensure accuracy and consistency.
  • Manage a specific portfolio with a specific service agreement to meet client needs and expectations.

About the Role:

This is an exciting opportunity to join our team as a Claims Executive at Asalus Corporation (IntelliCare). In this role, you will be responsible for handling a variety of tasks related to claim management, including investigating claims, resolving disputes, and maintaining accurate records.

Responsibilities Include:

  • Investigating and resolving complex claims in a fair and timely manner
  • Maintaining accurate and up-to-date records of claims processing and resolution
  • Providing excellent customer service and support to clients
  • Working closely with colleagues to ensure consistent and high-quality results