Claims Processor

We are seeking a detail-oriented and proactive PhilHealth claims processing assistant to join our team. The successful candidate will be responsible for managing administrative and clerical tasks related to PhilHealth claims processing, ensuring accurate and timely submission of claims, and maintaining compliance with all relevant regulations.

• Schedule and receive PhilHealth claims and related documents from Renal Clinic branches.
• Review each document for completeness and accuracy, analyzing any variances in accordance with PhilHealth policies.
• Determine patient benefit coverage and ensure utilization does not exceed available benefits.
• Verify that the number of claims submitted aligns with the transactions reported in financial reports.
• Collaborate regularly with the Accounts Receivable Analyst and Team Lead to ensure quality monitoring and timely submission of PhilHealth claims.
• Update monitoring reports and maintain files necessary for claims filing and other administrative tasks.
• Stay informed about updates and circulars related to hemodialysis by regularly checking the PhilHealth website.

• Educational Background:
  • Bachelor's degree in Accounting, Business Administration, Finance, or a related field.
• Technical Skills:
  • Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.
  • Familiarity with hospital billing software and electronic claims systems is an advantage.
• Administrative and Organizational Skills:
  • Strong administrative abilities with excellent organizational skills.
  • High degree of accuracy and attention to detail in handling documents and data.
• Additional Qualifications:
  • Knowledge of PhilHealth policies and procedures is preferred.
  • Effective communication and interpersonal skills.
  • Ability to work independently and collaboratively in a team environment.