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Medical Claims Review Specialist

2 weeks ago

Makati City, National Capital Region, Philippines Manulife Insurance Malaysia Full time
Job Description

As a Senior Health Claims Analyst at Manulife Insurance Malaysia, you will be responsible for reviewing and assessing health insurance claims. This involves determining the eligibility of benefits based on submitted documents and policy provisions.

You will work closely with our team to ensure that claims are processed efficiently and effectively, adhering to regulatory requirements and company policies. This position requires strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills.

You will be responsible for:

  • Determining eligible benefits based on documents submitted and policy provisions
  • Adjudicating claims and determining corresponding recommendation or decision within prescribed approval limits and within the defined turnaround time
  • Reviewing recommendations and decisions referred by the Third-Party Administrator (TPA) for approval
  • Maintaining accurate records of claims, communications, and resolutions in the claims management system

We are looking for candidates with at least three years' experience in life and health claims processing, insurance, or a related field. A Bachelor's degree in healthcare administration, business, or a related field is preferred. Industry certifications or exams passed (FLMI, etc.) are also highly valued.