Health Claims Adjudicator

1. Properly adjudicate reimbursement claims on outpatient, inpatient benefits of policyholders on a health policy.
2. Accurately determine if a medical condition is a covered benefit based on the policy provisions, terms, and conditions.
3. Adjudicate reimbursement claims in accordance with the different processes within defined authority limit and escalate to the next level approver if necessary.
4. Conduct proper investigation on claims if needed.
5. Research required information using available resources. as well as Handle, manage, and resolve customer complaints.
6. Following up on complicated customer inquiries as required.
7. Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.
8. Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests. Escalate where necessary in accordance with claims guidelines and procedures.
9. Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.
10. Provide backup for any support functions.
11. Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.
12. Accomplishes company goals by taking ownership of work responsibilities and constantly identify opportunities for work process improvement.
13. Ensure legal compliance by following company policies, procedures, guidelines ad well as local insurance regulations and statute.
14. Adhere to strict data protection protocols by keeping claims and sensitive medical information highly confidential.

1. Candidate must have a Bachelor's/College Degree. Medical background is preferred but not required. Health claims work experience is considered to be more relevant.
2. Candidate must have least 5 years experience in adjudicating health claims
3. Must possess excellent communication skills with ability to effectively articulate health product terms and condition as well as the reason for claims decision. Call center experience is preferred.
4. Above average working knowledge of insurance operational processes.
5. Customer centric and must advocate the Customer First mindset.
6. Highly developed sense of integrity
7. Pleasant, patient and friendly attitude; sociable personality
8. Detail oriented, highly organized, and possesses problem solving skills
9. Excellent and strong negotiation and influencing skills.

A global leader in insurance and investments, AXA takes care of 103 million lives in 64 countries worldwide. We actively invest in pioneering and personalized solutions to meet your ever-changing needs and exceed your expectations. In the Philippines, we are in partnership with Metrobank, one of the country's strongest banks.

Established in 1999, AXA Philippines is one of the largest and fastest growing life insurance companies in the country. It offers financial security to more than one million individuals through its group and individual life insurance as well as general insurance products through its subsidiary Charter Ping An.

AXA Philippines is one of the first to introduce bancassurance operations in the country, and is among the pioneers in the investment-linked insurance sector.

AXA now offers a complete range of products for all its customers' insurance and financial protection needs, including savings and investments, health plans, income protection, and health coverage; and through its general insurance subsidiary Charter Ping An Insurance Corporation\: fire, motor car, marine cargo, personal accident, bonds, casualty, and engineering insurance products.

AXA Philippines closed 2017 with P26.4 billion in total premium income and P5.7 billion in gross written premiums from Charter Ping An. Today, AXA has more than 4,000 financial advisers in 36 branches, and 700 financial executives in over 900 Metrobank and PSBank branches nationwide. Charter Ping An, on the other hand, has 22 branches nationwide and 2,007 agents.

AXA Philippines is a joint venture between the AXA Group, headquartered in France, and the Metrobank Group, one of the largest financial conglomerates in the Philippines.

The Metrobank Group is a conglomerate of industry-leading businesses that includes First Metro Investment Corporation, Metrobank Credit Cards, Federal Land, Toyota, and Manila Doctors Hospital. It was hailed Best Bank in the Philippines in 2010, 2011, and 2012 by Euromoney and recognized as the strongest bank in the Philippines by The Asian Banker in 2013. It is owned by the Ty Family whose major business interests include financial services, real estate development, power, and manufacturing.