Medical Claims Processor

15 hours ago

Mandaluyong City, National Capital Region, Philippines ActiveOne Health Full time ₱400,000 - ₱800,000 per year

Job Objective / PurposeThe Claim Processor is responsible for timely processing of medical claims based on the member's health benefit program. They analyze medical information, perform data entry, handle reimbursement claims, and decide whether a claim should be covered or denied. Communicate issues or exceptions to other concerned departments as necessary.

This role will be hired under Flexicare, Health Delivery System, Inc. (HDSI)—a subsidiary of RelianceUnited for a 4-month fixed-term contract.

Duties and Responsibilities:

  • Process claims by reviewing, researching, investigating, and adjudicating claims.
  • Authorize the appropriate payment or refer/escalate claims to concerned parties for further review.
  • Adjudicate claims, analyze validity, identify trends, and provide reports if necessary.
  • Communicate any discrepancy of claims.
  • Consistently meets established productivity, schedule adherence, and quality standards. Suggest any process improvement ideas to the team lead that would greatly impact the process.
  • Attend any developmental training for career and personal development.

Background and Qualifications:

  • Candidates must possess at least a bachelor's/college degree in any field.
  • Prior experience in claim reconciliation within the HMO or insurance industry is preferred.
  • Ability to do on-site visits and extend beyond company operating hours when needed.
  • Good communication and critical thinking skills.
  • Knowledgeable of Google platforms such as, but not limited to, GDocs, GSheets, etc., and MS Office.
  • Ability to handle multiple tasks in a timely manner on a continual basis under strict deadlines.
  • Strong planning, organization, and follow-up skills.
  • Proven ability to work independently and as a team member
  • Adheres consistently to the company values

Work Conditions:

  • Onsite work setup
  • Work Schedule: Mondays-Fridays, 8:00AM - 5:00PM
  • Assigned in Greenfield District, Mandaluyong City
  • Occasional travel to build partnerships with institutions and organizations may be expected, as well as attendance at relevant conferences and events

______________________________________

Visit the RelianceUnited Website here:

What it's like to Work at RelianceUnited:

Job Type: Fixed term

Contract length: 4 months

Pay: From Php20,000.00 per month

Benefits:

  • Company events
  • Staff meals provided

Work Location: In person

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