Claims Analyst

3 days ago

Taguig, National Capital Region, Philippines Ascendion Full time $320,000 - $640,000 per year

General Description:

This position is responsible for the overall review, assessment, and decision of claims.

Responsibilities:

  • Determine eligible benefits based on documents submitted and policy provisions.
  • Adjudicate claims and determine corresponding recommendation or decision within rescribed approval limits and within the defined turnaround time.
  • Ensure accurate benefit payouts in accordance with the policy details, laws and regulations.
  • Assist junior adjudicators with complex claims beyond their authorities.
  • Escalate possible fraudulent claims to the Team Lead and recommend appropriate action.
  • Actively participate in and contribute to projects and initiatives.

Skill Set

  • Excellent written and oral communication skills
  • Highly analytical
  • Excellent understanding of life insurance policy provisions
  • Understands common medical terms and illnesses
  • With knowledge and understanding of insurance laws and regulations
  • Quick thinker and can work independently under pressure

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