Claims Analyst

3 days ago

Makati City, National Capital Region, Philippines Pioneer Insurance Full time ₱900,000 - ₱1,200,000 per year

Roles and Responsibilities

  • Verification of cover in order to determine if indeed there is coverage/policy in-force when the loss occurs
  • Makes the necessary recommendation on a claim (such as for final action or to require further documents or information) or makes a final decision on claim, in accordance with the claim's authority
  • Handles the necessary communication that should be provided to claimants
  • Ensures proper documentation of cases evaluated
  • Handles inquiries of the status of a claim
  • Provides claimants with appropriate and prompt explanation of claims benefits which may not be payable or limited
  • Assesses additional or new information on a denied claim or a claim with limited benefits payout and determine if there are grounds for consideration or a revised recommendation
  • Maintains the confidentiality of claims records
  • Should at all times meet the department's standards for quality and turnaround time
  • Deals with third-party administrations (TPAs), adjusters and other service providers
  • Performs other duties as necessary in meeting the objectives/mission of the department or as assigned by superior

Qualifications

  • Graduate of a bachelor's degree course (preferably
    medical allied
    and/or
    agribusiness
    )
  • At least 3 years' work experience in similar capacity
  • Proficient in Microsoft Office
  • Amenable to fully work onsite
  • Proficient in the use of MS Office

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