Claims Analyst

We are seeking a detail-oriented and analytical Data Analyst – Claims to join our team. The ideal candidate will be responsible for analyzing claims data, identifying trends and anomalies, and providing actionable insights to improve operational efficiency, reduce costs, and enhance customer outcomes. This role bridges data analytics with claims...

This Sr. Claims Analyst position is responsible for the overall review, assessment, and decision of claims.Position Responsibilities:Determine eligible benefits based on documents submitted and policy provisions.Adjudicate claims and determine corresponding recommendation or decision within prescribed approval limits and within the defined turnaround...

YOUR ROLEVerification of cover in order to determine if indeed there is coverage/policy in-force when the loss occursMakes the necessary recommendation on a claim (such as for final action or to require further documents or information) or makes a final decision on claim, in accordance with the claim's authorityHandles the necessary communication that should...

Purpose of This Role: Regular account visitation to address customer needs or concerns in prompt and professional manner. Maintaining mutually beneficial business relationship with GPs clients by ensuring accurate and timely processing of claims requests and settlement of valid claims. Meeting needs of customers (internal or external) by addressing or...

Role Title:Claims Operations Analyst - Commercial InsuranceECLARO:A quick SummaryECLARO is an award-winning professional services firm headquartered in New York City and operating in the U.S., Canada, UK, Ireland, Australia and the Philippines. We are dedicated to a singular purpose: providing the Right People to meet every client's needs and solve business...

JOB OVERVIEWWe are seeking a detail-oriented and proactive PhilHealth Claims Processing Assistant to join our healthcare administration 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...

JOB PURPOSE:Responsible for analyzing, adjudicating, auditing and processing of claims (Member's Reimbursement) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements).Principal Accountability:Ensures accurate and timely processing of claims from medical service providers within authority limits. This...

  Position Overview:The Nurse Utilization and Clinical Advisor Services Analyst IV is responsible for applying clinical expertise to drive improvements in healthcare resource utilization, cost, and quality. This role focuses on analyzing healthcare cases and claims, providing guidance on the appropriateness of care, and coordinating with clients and...

The A/P Analyst reviews all reimbursements, cash advances (CA), CA liquidations and statutory payments for appropriate documentation and approval prior to payments. He/She is responsible in investigating discrepancies in claims and supporting documents and as per company policies and is responsible to ensure all employee reimbursements and claims are paid...

Communicate with policyholders, detect potential fraud, maintained detailed records, ensure timely and compliant claims resolution.Qualifications:Bachelor's degree in business accountancy, IT, or a related field (preferred) or Medical Allied CourseKnowledgeable in MS-Office especially Excel / Data AnalyticsPrior experience in insurance claims processing or...