Healthcare Operations Specialist

2 days ago


Pasig, National Capital Region, Philippines Hive Health Pte Ltd Full time

About Hive Health Pte Ltd

Company Overview

Hive Health Pte Ltd is part of the Hive Health Group of Companies, committed to providing comprehensive digital health plans for small-medium enterprises (SMEs) in the Philippines.

The company's 30+ years of experience in care provision and innovative tech capabilities enable the Hive Health Group to offer hassle-free health solutions through their all-in-one platform.

About the Role

This Medical Adjudication Specialist Contractor will play a key role in optimizing healthcare operations by meticulously reviewing, analyzing, and validating medical availments and claims.

They will work closely with other functions to continuously deliver user experience improvements and introduce best-in-class strategies and processes.

Responsibilities
  • Provide clinical guidance on ambiguous cases to facilitate approvals of medical availments.
  • Review, adjudicate, and approve inpatient discharges ensuring accurate coverage decisions.
  • Lead critical weekend and after-hours support for urgent cases.
  • Evaluate member utilization by analyzing claims data.
Qualifications
  • At least 3 years of relevant clinical experience with familiarity on health coverage policies.
  • Creative problem-solving skills, proactive attitude, and growth mindset.
  • Excellent verbal and written communications, team player with adaptability.


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