Claims Manager

18 hours ago

Makati City, National Capital Region, Philippines CXC Philippines Full time ₱2,160,000 - ₱2,300,000 per year

We are seeking an experienced and detail-oriented Claims Manager to oversee the end-to-end claims management process within our organization. The ideal candidate will have strong knowledge of insurance and/or healthcare claims operations, regulatory requirements, and industry best practices. This role plays a critical part in ensuring fair, efficient, and timely settlement of claims, while maintaining compliance and delivering exceptional customer service.

Key Responsibilities:

  • Lead and manage the claims department, ensuring all claims are handled promptly, accurately, and in accordance with company policies and industry regulations.
  • Oversee claims assessment, investigation, adjudication, and settlement processes, including escalated or complex cases.
  • Develop, implement, and monitor claims handling procedures to improve efficiency, accuracy, and customer satisfaction.
  • Provide training, mentorship, and performance management to claims staff, fostering a culture of accountability and continuous improvement.
  • Collaborate with underwriters, providers, legal teams, and third-party administrators to resolve claims disputes and ensure equitable outcomes.
  • Monitor claim trends, identify potential risks, and provide recommendations to reduce costs and improve processes.
  • Prepare reports and analysis for senior management, highlighting claim performance, operational metrics, and regulatory compliance.
  • Ensure adherence to relevant laws, industry standards, and data privacy requirements.

Qualifications:

  • Bachelor's degree in Insurance, Healthcare Management, Business Administration, or a related field (Master's preferred).
  • 5+ years of experience in claims management within the insurance or healthcare industry, with at least 2 years in a leadership role.
  • Strong knowledge of claims regulations, policies, and compliance standards.
  • Excellent analytical, problem-solving, and negotiation skills.
  • Proven leadership ability with strong communication and stakeholder management skills.

Job Types: Full-time, Permanent

Pay: Php180, Php230,000.00 per month

Benefits:

  • Health insurance
  • Life insurance
  • Work from home

Experience:

  • claims management in the insurance or healthcare industry: 5 years (Required)

Work Location: In person

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