Claims Processing Specialist I

7 days ago

Quezon City, National Capital Region, Philippines StayWell Information Systems, Inc. Full time ₱300,000 - ₱450,000 per year

Review and evaluate data on claim forms and supporting documents.

Process for payment on- and off-island medical, dental, and pharmacy claims.

Review and verify authorized charges on claim statements.

Prepare correspondence to providers regarding billing issues and benefit coverage.

Handle data entry of medical, dental and pharmacy claims into the computer for processing.

Re-evaluate evidence and obtain additional information in connection with claims pended, denied or under appeal.

Ensure that all claims and payments are reconciled.

Coordinate daily activities, including handling of complaints, with various departments such as enrollment and customer care.

Ensure participation to various company programs, activities and committees, such as but not limited to training and development programs, collegial planning, collaborative ad-hoc projects, and other company-sponsored events, as necessary.

Adhere to all set Organization policies, procedures and standards, and promote culture of compliance and continuous improvement among the existing manpower pool.

Adhere to all policies, procedures and standards set by the company, and help promote the culture of compliance and continuous improvement within the Organization.

Perform job functions consistent with the company's vision and mission statements, and core values.

Perform other duties, roles and responsibilities analogous, related, similar, germane and/or implied to the above-mentioned.

Requirements:

  • Doctor of Dental Medicine, or Bachelor's Degree in Nursing, Pharmacy or any allied medical fields
  • Computer literate, preferably with working knowledge in using MS Office Suite (Word, Excel, PPT, etc.)
  • Knowledge on basic medical terminology and claims procedures
  • Ability to solve basic claim issues and concerns
  • Basic business communication skills
  • Knowledge of basic accounting principles

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