Claims Reviewer

Job roleReviews and approves claims within the assigned scope/level of authority and standard turnaround time.Maintains effective communication, coordination, and good relationship with clients, concerned business units, and other parties involved in the claims review process.Keeps abreast of external and internal opportunities for skills development and...

Job PurposeThe Claims Evaluator/Examiner is responsible for investigating, evaluating, and processing non-life insurance claims in accordance with company policies, procedures, and regulatory requirements. The role ensures timely, fair, and accurate settlement of claims while maintaining excellent customer service and minimizing company losses.Roles and...

Description of the Functions of the DepartmentThe department is responsible for processing the claims and determining whether payment should be made. The department ensures that the following are observed:Checks validity/compensability of claims based on the plan coverage/balance and limits up-to-date membership fee payment (active status) completeness of...

Reviews required documents submitted by the insured to verify compensability of the claim.Reviews parts for comparative assessment if repairs to be done at non dealership/Non Casa Negotiate claims settlement.   Update correct loss reserves in SCPerforms proper Tagging of claim cost in SCReviews final report/recommendation of independent...

Reviews required documents submitted by the insured to verify compensability of the claim.Reviews parts for comparative assessment if repairs to be done at non dealership/Non Casa Negotiate claims settlement.   Update correct loss reserves in SCPerforms proper Tagging of claim cost in SCReviews final report/recommendation of independent...

OVERVIEWReview and evaluate claim fairly and promptly, from registration to payment to Insured, third parties and service providers, in compliance to Policies, Regulations and Guidelines set by the company.Job Description:Register claims, book its loss reserves and send loss advices to reinsurers.Review, evaluate/re-evaluate, recommend claim, establish its...

Must possess any medical-related field degree;With HMO experience is an advantage but not required;Reviews insurance claims for accuracy and completeness;Verify policy details and coverage;Investigate claims by gathering necessary information from claimants, witnesses, and other relevant parties.;Evaluate claims based on policy provisions and determine the...

Work Set-Up: In-Office Training Required | Potential for Remote Work After TrainingLocation: Makati, ValeroExpected Start Date: December 8, 2025Position Summary:We are seeking a dynamic and experienced Healthcare Claims Adjudication Lead to oversee our growing healthcare team. This role is pivotal in ensuring timely, accurate, and compliant processing of...

Provider Dispute Claims Processor | Urgent HiringWork Set-Up: In-Office Training Required | Potential for Remote Work After TrainingLocation: Makati, ValeroExpected Start Date: December 8, 2025Position Summary:We are seeking an experienced Provider Dispute Claims Processor to join our growing healthcare team. This role is responsible for reviewing,...

Work Set-Up: In-Office Training Required | Potential for Remote Work After Training)Location: Makati, ValeroExpected Start Date: December 8, 2025Your next career move starts here – submit your application todayPosition Summary:We are seeking an experienced Provider Dispute Claims Processor to join our growing healthcare team. This role is responsible for...