Health Claims Officer

3 days ago


Makati City, National Capital Region, Philippines Trinity Workforce Solutions, Inc. Full time

Trinity Workforce Solutions, Inc. seeks a highly skilled Health Claims Officer to join our team in Makati. As a Health Claims Officer, you will be assigned to various hospitals across the country and provide support services to health clients in Metro Manila, Metro Cebu & Davao areas.

About the Role

The role of a Health Claims Officer is centered on customer management to achieve integrated care outcomes for hospitalized clients. You will work closely with hospitals, doctors, clinics, and other stakeholders to ensure seamless health customer journeys.

Main Responsibilities
  • Assess and adjudicate hospitalization claims of insured members in real-time.
  • Analyze medical documents related to hospitalization to make accurate claims decisions.
  • Approve claim amounts up to P500K and escalate beyond that limit.
  • Effectively communicate benefits of health insurance plans to customers and agents both verbally and in writing.
  • Conduct case management to ensure a seamless health customer journey for hospitalized clients.
  • Facilitate administration of health benefits to all members/policy holders through coordination between patients and providers.
  • Develop and maintain strong relationships with third-party providers, TPA, and doctors/hospitals/clinics.
  • Monitor performance of AXA LOs and resolve or escalate issues when necessary.


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