Medical Claims Manager

1. CLAIMS PROCESSINGEnsures accurate review of claims document like LOA, hospital bills/SOA, concurrent review form, physician's report, original OR for use in processing claims.2. CLAIMS REVIEW/ EVALUATION/ ADJUDICATIONReviews/evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards3....

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...

Medical Claims SpecialistWe are seeking an experienced Medical Claims Specialist to collaborate with our team. This role involves verifying patient eligibility, reviewing patient bills, and communicating with insurance companies.Responsibilities:Verify patient eligibility and benefits for treatments, hospitalizations, and procedures.Review patient bills for...

Medical Billing Specialist RoleAbout the JobWe are seeking a skilled Medical Billing Specialist to join our team. As a key member of our organization, you will be responsible for preparing and submitting medical claims to insurance companies.Your primary focus will be on ensuring that all necessary information is accurate and up-to-date, collecting and...

Job OpportunityWe are seeking an experienced professional to fill a Medical Billing Specialist position within our expanding team.About the RoleVerify patient eligibility and benefits for various treatments, hospitalizations, and procedures.Review and verify patient bills for accuracy and completeness, and obtain any necessary information.Follow up on unpaid...

Medical Billing SpecialistWe are seeking a Medical Billing Specialist to support accurate and timely claims submission, payment posting, and account reconciliation.This role ensures compliance with payer guidelines and directly contributes to the healthcare provider's revenue cycle.As part of our team, you will work with cross-functional teams to deliver...

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...

We are looking for a Claims Manager who will take full ownership of the claims function in the Philippines. This role ensures that all claims are handled efficiently, fairly, and in line with regulatory standards. The Claims Manager will lead a team of specialists, drive process improvements, and deliver a high level of service to clients and partners.Key...

About the role We are seeking an experienced Claims Manager (Non-Life) to join our dynamic team at Manila Bankers Assurance in Makati City, Metro Manila. As the Claims Manager (Non-Life), you will play a crucial role in overseeing the efficient and accurate processing of claims for our non-life insurance business, contributing to the overall success and...

Claims Resolution SpecialistWe are seeking a skilled Claims Resolution Specialist to join our team. In this role, you will be responsible for processing claims, providing recommendations and final decisions based on set authority limits approved by management.About the RoleThis position involves coordinating with team members and other stakeholders to ensure...