Claims Specialist

2 days ago

Bonifacio Global Metro Manila, Philippines HGS Offshore Staffing Solutions Full time ₱900,000 - ₱1,200,000 per year

POSITION OVERVIEW

Claims Processors are involved in managing a claim from beginning through to settlement. They ensure that claims are handled efficiently and that payment for valid claims is made to their policyholders. Claims Processors decide on the extent and validity of a claim by checking for any potential fraudulent activity. They liaise with external experts such as loss adjusters and lawyers and may be involved in legal discussions about the recovery of money from the party responsible for the loss. Claims Processors do much more than simply fill out paperwork. They have to analyze the data that they are given to recommend an informed decision and keep with their company's standards

POSITION DESCRIPTION

  • Interact with customers and act as a liaison between clients and companies by providing information to address inquiries regarding products and services
  • Assist and help resolve any client inquiries, errors, account questions, billing, cancelations, and other queries about products and services
  • Answer questions, offer advice, resolve routine problems in service, and serve as advocates for client's customer service brand
  • Process new Claims policies, modify existing ones and obtain information from policyholders to verify the accuracy of their accounts
  • Calculate the amounts of claims, apply rating systems to claims, contact people involved in claims to obtain relevant information and recommend claim actions
  • Assist claimants, providers and clients with problems or questions regarding their claims and/or policies whilst complying with state laws, policy and company procedures
  • Listening attentively to customer needs and concerns; demonstrate empathy while maximizing opportunity to build rapport with the customer
  • Confirm customer understanding of the solution and provide additional customer education as needed
  • Make follow up outbound calls to customers and other parties as a part of case resolution process
  • Ensure all client enquiries are recorded into the system, confirming all contact details of the enquirer with 100% accuracy
  • Reviews claims thoroughly and to makes sure that all information are complete and correct; updates records of claims and follow up on lapsed cases
  • Provide well-rounded, prompt, high-quality, and professional client service at all times
  • Any other task/duty as directed by client/management

POSITION REQUIREMENTS

  • Candidate must possess at least an Associate's or Bachelor's/College Degree
  • With at least 2 years of work experience in a similar role
  • Proficient in using Microsoft Office applications and is tech savvy
  • Previous experience in the healthcare industry is an advantage
  • Ability to be flexible, adaptable and adjust in a fast-paced work environment
  • Excellent command of the English language, and is an effective communicator both orally and written
  • Strong customer service orientation and people skills
  • Must have patience, empathy and self-control to deal with angry, emotional or frustrated clients
  • High critical thinking skills such as reasoning, logic and judgment to solve a variety of coverage-related issues

  • Marketing Claims Specialist

    20 hours ago

    , Metro Manila, Philippines Buscojobs Full time

    It's fun to work in a company where people truly BELIEVE in what they're doing Ingram Micro is a leading technology company for the global information technology ecosystem. With the ability to reach nearly 90% of the global population, we play a vital role in the worldwide IT sales channel, bringing products and services from technology manufacturers and...

  • Medical Claims Analyst

    20 hours ago

    , Metro Manila, Philippines Buscojobs Full time

    Overview We are looking for Claims Analyst to be part of our PIONEER TEAM You'll be responsible for managing the entire claims process from initiation to resolution, ensuring accuracy, compliance, and efficiency. This role involves analyzing and processing healthcare claims, identifying discrepancies, and working closely with internal teams and clients to...

  • Claim Specialist

    1 week ago

    Manila, National Capital Region, Philippines Emapta Full time ₱900,000 - ₱1,200,000 per year

    Master the Art of Precision in Claims ManagementTurn every dispute into an opportunity for accuracy and efficiency. In this role, your expertise in claims and dispute resolution will connect you to international opportunities in accounting and finance. Build a global career, make your mark in the industry, and leave a lasting legacy while enjoying the...

  • Life And Health Claims Officer

    24 hours ago

    , Metro Manila, Philippines Buscojobs Full time

    Life And Health Claims Officer jobs in Makati Postings include various life and health claims roles in Makati and nearby areas with responsibilities spanning claims processing, leadership in claims teams, and senior management in claims operations. Insurance Adjuster Posted today Graduate of Accountancy Computer literate Good moral character ...

  • Claims Specialist Earned Up To 30K Monthly Salary

    22 hours ago

    , Metro Manila, Philippines Buscojobs Full time

    Makati City, National Capital Region ₱ - ₱ Y Pioneer Your Insurance Posted today Job Description Job Summary: The Claims Adjuster is responsible for investigating and processing claims for non-life insurance policies, ensuring fair and timely settlement in line with company policies and industry regulations. Job Description: Investigate and assess...

  • Finance and Claims Analyst

    4 days ago

    Manila, National Capital Region, Philippines Damage Control Project Management Full time ₱900,000 - ₱1,200,000 per year

    Client-Side Project Management Consultancy – Natural Disaster RecoveryWork from Home – Australia BasedWe are specialist client-side project management consultancy firm delivering critical infrastructure and recovery support for natural disaster events across Australia. We are currently seeking aFinance and Claims Analystto join our remote team on a...

  • Client Intake

    20 hours ago

    , Metro Manila, Philippines Emapta Full time

    Overview Where Caregivers Get the Care They Deserve. Our client is transforming the future of caregiving by putting family caregivers at the center of care . Through hourly compensation, personalized coaching, peer communities, and AI-powered tools, they empower caregivers to support loved ones with dignity—without sacrificing their own well-being. Backed...

  • Claims Analyst

    6 days ago

    Manila, Philippines Health Business Solutions LLC Full time

    Job Summary: We are seeking a detail-oriented and experienced Insurance Denials Management Specialist to join our team, specializing in hospice claims. The ideal candidate will have a strong background in analyzing, appealing, and resolving insurance denials to optimize reimbursement and ensure compliance with hospice care billing regulations. Key...

  • Case Manager/Claims Specialist

    21 hours ago

    , Metro Manila, Philippines Buscojobs Full time

    Case Manager Claims Specialist English - Makati Job Description: Our company is looking for Online English Teachers who are willing to teach Korean students. Our team provides comprehensive training and support to ensure that our teachers are equipped with the necessary skills and tools to deliver effective English lessons online. Job Requirements:...

  • Insurance and Medical Claims Specialist

    4 days ago

    Manila, National Capital Region, Philippines MOXI Global Corporation Full time ₱450,000 - ₱750,000 per year

    MUST:Candidates should have at least 2 years of insurance agency or broker experience.Must be an advanced user of Microsoft Excel and CRM tools.Must have experience in any of the following: Claims Management / Claims Processing/ Insurance Claims / Medical Claims ReviewMust have knowledge about State Workers' Compensation LawsThe position manages and...