Claims Assistant

1 week ago

Ortigas Metro Manila, Philippines MEDICARE PLUS, INC. Full time ₱300,000 - ₱450,000 per year

Job Summary:

The Claims Assistant provides administrative support to the claims department by processing, organizing, and managing claim-related documents and data. They assist claims adjusters and other team members in handling insurance claims efficiently and accurately. The Claims Assistant plays a crucial role in ensuring that claims are processed in a timely manner and that all necessary documentation is properly maintained.

Responsibilities:

1) Document Management:

a) Receive, sort, and review incoming claim documents and correspondence.

b) Create and maintain electronic and physical claim files.

c) Organize and index documents for easy retrieval.

d) Ensure all documents are accurately labeled, logged, and stored.

2) Data Entry and Processing:

a) Enter claim information into the database or claims management system.

b) Verify data accuracy and completeness.

c) Update claim status and information as required.

d) Generate standard reports and claims-related documents.

3) Communication and Coordination:

a) Assist in responding to customer inquiries regarding claim status and process.

b) Coordinate with internal teams, external vendors, and clients as needed.

c) Maintain regular communication with claims adjusters and provide necessary support.

d) Assist in scheduling appointments, meetings, and inspections.

4) Claim Support:

a) Review and assess claim documents for completeness and accuracy.

b) Assist in determining initial coverage eligibility.

c) Prepare claim-related correspondence, including acknowledgment letters and denial notifications.

d) Support claims adjusters in the investigation and evaluation of claims.

5) Record Keeping and Compliance:

a) Ensure compliance with regulatory requirements and internal policies.

b) Maintain confidentiality and handle sensitive claim information appropriately.

c) Assist in maintaining accurate records of claim activities, payments, and settlements.

d) Collaborate with the legal department to gather information for legal proceedings, if necessary.

6) Process Improvement:

a) Identify opportunities to streamline claim processes and enhance efficiency.

b) Make suggestions for improvements in workflows and procedures.

c) Participate in departmental meetings and provide input on process enhancements.

d) Contribute to the implementation of new technology or software solutions.

Requirements:

· Graduate of any 4 year course, preferably with a Medical Background

· Previous experience in an administrative or data entry role, preferably in the insurance industry.

· Familiarity with claims processing and insurance terminology is advantageous.

· Proficiency in using computer systems, databases, and MS Office applications.

· Excellent organizational skills and attention to detail.

· Strong written and verbal communication skills.

· Ability to handle multiple tasks simultaneously and prioritize workload.

· Basic understanding of confidentiality and data protection principles.

· Team player with a positive attitude and willingness to learn.

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