Medical Claims Lead

7 hours ago

Parañaque P, Philippines 906dd8a1-f840-4364-8c26-dc03b1d0b73a Full time ₱840,000 - ₱1,080,000 per year

Job Description:

  • Collaborate closely with the Lead Nurse, Crew Health Services and PEME Crew Case Management Specialists to enhance workflow efficiency by supporting seamless departmental operations.
  • Oversee the end-to-end processing of medical claims for cruise ship crew, including onboard incidents, port-based treatments, and repatriation cases.
  • Ensure all claims are handled in accordance with DMW regulations, MLC 2006, and flag state requirements
  • Liaise with manning agencies, local hospitals, diagnostic centers, and the MSC medical and legal departments to validate claims and gather documentation.
  • Coordinate with P&I Clubs and insurance providers for claim approvals, reimbursements, and dispute resolution.
  • Track ongoing medical cases, including follow-up treatments, disability assessments, and return-to-work evaluations
  • Prepare regular reports on claims trends, costs, and case outcomes for internal and external stakeholders.
  • Manage appeals and contested claims, ensuring fair and timely resolution in line with legal and contractual obligations.
  • Provide guidance and training to clinical case managers and support staff on maritime medical claims procedures.

Qualifications:

  • Bachelor's degree in nursing, healthcare administration, maritime studies, or a related field.
  • Nurse with a license to practice and valid registration to a relevant governing body.
  • At least 5 years of experience in medical claims processing, with 2+ years in a supervisory or managerial role.
  • Familiarity with DMW regulations, MLC 2006, and maritime health protocols.
  • Experience working with or for manning agencies, cruise lines, or maritime insurance providers is highly preferred.
  • Strong understanding of ICD-10 coding, electronic health records systems, medical billing, and insurance adjudication.
  • Preferred Skills: o Registered Nurse (RN) license in the Philippines is a plus. o Experience dealing with international healthcare providers and repatriation logistics. o Ability to work flexible hours to coordinate with global stakeholders.
  • Proficiency in Microsoft Office and claims management systems.
  • Strong communication skills in English and Filipino; knowledge of other regional languages is a plus

For us to proceed with your application, please register your application in this link:

Job Types: Full-time, Permanent

Pay: Php70, Php90,000.00 per month

Benefits:

  • Company events
  • Life insurance
  • Opportunities for promotion
  • Pay raise

Work Location: In person

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