Operations Coordinator and Claims Administrator

2 hours ago

Makati City, National Capital Region, Philippines Inova Care USA Full time ₱250,000 - ₱750,000 per year

Position Overview

We are seeking a detail-oriented and proactive Operations Coordinator / Claims Administrator to join our team. This role is critical in ensuring seamless execution of claims processing, customer service, and provider relations functions in alignment with company standards. The position requires strong organizational skills, adaptability, and the ability to manage multiple priorities effectively. While the main function will be assigned upon onboarding, responsibilities may rotate between claims administration and operational support based on business needs.

Key Responsibilities

Claims Administration:

  • Register all received claims on the same day and ensure proper date stamping.
  • Check claim documents for completeness and communicate missing requirements to providers or members.
  • Maintain accurate reconciliation logs of all claim documents.
  • Assign claim numbers based on receipt date and sequence.
  • Scan and store claim documents in designated shared folders within 24 hours.
  • Reconcile daily scanned claim volumes and report discrepancies to the supervisor.
  • Distribute claims to appropriate encoders.
  • Support other tasks related to claims management as assigned.

Operations Coordination:

  • Perform claim analysis and prepare medical billing reports (MBRs) according to service level standards.
  • Compile, verify, and analyze claim data; prepare client payment reports.
  • Investigate potentially fraudulent claims or MBRs.
  • Review and secure necessary approvals from policyholders and providers.
  • Provide quality customer service via phone and digital platforms for inquiries related to benefits, appointments, and claims.
  • Document and update call logs, complaint records, and generate routine activity reports.
  • Coordinate members' healthcare needs according to benefit plans.
  • Ensure compliance with all policies and procedures across markets.

Service Level Requirements

  • 100% of claims date and time stamped upon receipt.
  • 100% of claims registered in reconciliation logs on the receipt date.
  • 100% of claims scanned and uploaded within 24 hours.
  • Incomplete claim checklist sent to provider/member within 24 hours.

Skills & Qualifications

  • Degree in Business, Insurance, or Medical Science.
  • Previous experience in claims processing or administration.
  • Excellent communication skills in English and local language.
  • Proficiency in MS Office, particularly Excel; familiarity with CRM tools is a plus.
  • Strong organizational and multitasking abilities.
  • Analytical and problem-solving skills with attention to detail.
  • Ability to prioritize and manage multiple tasks effectively.
  • Customer-focused mindset with commitment to service excellence.

Job Types: Full-time, Permanent

Work Location: In person

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