Medical Claims Analyst

5 days ago

Ayala Alabang, National Capital Region, Philippines Ifelse Ph Inc. Full time ₱456,000 - ₱480,000 per year

The Medical Claims Analyst will provide critical support to the Medical Claims Manager by assisting in the review, processing, and validation of medical insurance claims. This will include attending to calls coming from TPA partner to provide support on the escalated cases. This role requires strong attention to detail, knowledge of health insurance procedures, and the ability to analyze medical documents and billing. The ideal candidate is organized, analytical, and service-oriented, with a commitment to operational accuracy and customer satisfaction.

KEY RESPONSIBILITIES

A. Claims Processing & Analysis

  • Assist in the accurate and timely processing of inpatient and outpatient medical claims.
  • Validate medical documentation, hospital bills, and physician statements to ensure completeness and compliance.
  • Flag discrepancies or suspicious claims and escalate as needed to the Medical Claims Manager.
  • Input and update claims data in the system, ensuring accuracy and completeness.

B. Customer and Stakeholder Support

  • Coordinate with healthcare providers, TPAs, and policyholders to request missing documents or clarify submitted claims.
  • Support the team in responding to customer inquiries regarding claim status or documentation requirements.
  • Maintain professional and empathetic communication when handling claims-related queries.

C. Reporting & Administration

  • Generate and update regular claims reports to assist the Medical Claims Manager in monitoring trends and turnaround time (TAT).
  • Maintain organized records of claims, documentation, and correspondence for audit and compliance purposes.
  • Assist in documenting and improving internal procedures and workflows.

D. Compliance & Quality Control

  • Ensure claims are processed in compliance with internal guidelines and external regulations.
  • Support audit readiness by maintaining clean records and assisting with documentation checks as needed.

QUALIFICATIONS

  • With a Bachelor's degree in Nursing ( or any other related Allied Medical Course)
  • With extensive experience in Health insurance industry and HMO focusing on Claims and LOG issuance.
  • Analytical thinking and attention to detail
  • Familiarity with insurance policies and regulatory compliance
  • Can communicate with both internal and external clients and partners.
  • With commendable customer service skills
  • Has the ability to work independently

V. WORK SCHEDULE

  • Mondays to Fridays, 8AM to 5PM (subject for extensions depends on the urgency of the request and/or deadlines)

VI. WORK LOCATION

  • Acacia Ave., Madrigal Business Park, Muntinlupa

Company Benefits:

  • 14th Month Pay
  • HMO with 2 Free Dependents
  • Medical Allowance/Reimbursement
  • Performance Bonus
  • Christmas Cash Gift
  • 15 SL and VL
  • Leave Conversion

Job Type: Full-time

Pay: Php38, Php40,000.00 per month

Work Location: In person

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