Claims Specialist

2 days ago

Cebu City, Central Visayas, Philippines Generali Life Assurance Philippines Inc. Full time ₱900,000 - ₱1,200,000 per year

DUTIES AND RESPONSIBILITIES:

  • Checks availability and accuracy of claims details in the system
  • Makes necessary corrections of claims details
  • Processes and analyze claims using the prescribed process and based on existing policy contract and guidelines
  • Prepares transmittal of claims for payment
  • Approves payment for claims within the authority limit
  • Recommends approval of claims payment beyond authority limit
  • Reconcile claims with providers/accounts
  • Answer inquiries via email or phone regarding status of claims or overdue payments within set turn-around time
  • Documentation of medical claims disputes or complaints
  • Resolution or escalation of claims disputes or complaints within the TAT
  • Coordination with sales and other work units on claims or non-claims related customer concerns received via email or phone.
  • Reconciles statement of account (SOA) sent by providers
  • Coordinate with concerned departments on the items subject of reconciliation
  • Coordinate with the provider contact person to discuss issues or requests
  • Release of reconciled account within SLA

REQUIREMENTS:

  • College graduate with a degree in any medical or business-related discipline
  • At least two (2) years experience in medical or life claims processing
  • Preferably passed Life Office Management Association (LOMA) courses
  • Has ability to manage enterprise information (data, technology, tools, techniques, people, processes) to support decision-making, predictive analysis, optimization efforts and security analysis through ad-hoc analysis, standard reports, scorecards and dashboards and interactive visualizations
  • Has possesses current knowledge of all key products and services. Understands the benefits and constraints associated with these products and services. Utilizes knowledge to meet customer needs and gain a competitive advantage.
  • Has ability to leverage on third parties' value chain and customer base, creating a plug-and-play architecture & operating model, to enlarge own service portfolio and customer base.

Job Types: Full-time, Permanent

Benefits:

  • Additional leave
  • Company Christmas gift
  • Company events
  • Flexible schedule
  • Flextime
  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise
  • Work from home

Work Location: In person

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