Claims Adjudicator – Medical Facilities

1 week ago

Makati City, National Capital Region, Philippines PACIFIC CROSS INSURANCE, INC. Full time ₱400,000 - ₱800,000 per year

Your Role:

"We are in the business of paying claims"-  your role is to help us uphold this promise.

Job Summary:

The Claims Adjudicator for Medical Facilities is responsible for evaluating and processing claims from hospitals, laboratories, and clinics. This role ensures accredited facility partners receive their service payments based on approved limits.  they are entitled to while maintaining accuracy, compliance, and efficiency in claims processing.

Level: Supervisor/individual contributor

Responsibilities:

  • Claims Processing & Approval: Assess and process claims from medical facilities, ensuring they align with policy coverage and benefit limits. Compute overall utilization and approve claims within assigned authority levels.
  • Document Review & Verification: Examine supporting documents for legitimacy, completeness, and accuracy based on the plan schedule and policy guidelines.
  • Compliance & Data Management: Maintain and update records efficiently while adhering to Data Privacy Policies and regulatory requirements. Ensure all processed claims meet internal standards and external compliance regulations.
  • Reporting & Process Improvement: Monitor claim trends, identify potential issues, and provide insights to improve claims processing efficiency and accuracy.

Qualifications:

  • Must be a pharmacy, nursing or any allied medical course graduate
  • Experience in claims adjudication, medical billing, or healthcare insurance processing is preferred.

What's in it for you?

  • Impactful Work:Play a pivotal role in a team that genuinely makes a difference in people's lives by ensuring they receive the medical benefits they need. While the work may be high-stress, the outcome is incredibly rewarding as policyholders benefit directly from your efforts.
  • Continuous Growth: Engage in continuous learning and growth opportunities within a supportive team environment. Despite the challenges, we believe in nurturing your professional development every step of the way.
  • Competitive Compensation and Benefits: Recognizing the demands of our industry, we ensure your dedication is rewarded with a competitive compensation and benefits package.

Work set-up:

  • Hybrid: 80% onsite
  • Monday to Friday 8:30-5:30

We're excited about the possibility of having you on our team in the future

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