Philippines Job Openings

Hunter's Hub Inc.

Claims Senior Specialist

Makati City

FULL TIME

September 18, 2024

Job Qualifications:
  • Candidate must have a Bachelor's/College Degree. Medical background is preferred but not required.
  • Must have experience in Health claims work experience.
  • Candidate must have least 2 to 3 years experience in adjudicating health claims.
  • Must possess excellent communication skills with ability to effectively articulate health product terms and condition as well as the reason for claims decision.
  • Call center experience is preferred.
  • Working knowledge of insurance operational processes.
  • Customer centric and must advocate the Customer First mindset.
Duties and Responsibilities:
  • Properly adjudicate reimbursement claims on outpatient, inpatient benefits of policyholders on a health policy.
  • Accurately determine if a medical condition is a covered benefit based on the policy provisions, terms, and conditions.
  • Adjudicate reimbursement claims in accordance with the different processes within defined authority limit and escalate to the next level approver if necessary.
  • Conduct proper investigation on claims if needed.
  • Research required information using available resources. as well as Handle, manage, and resolve customer complaints.
  • Following up on complicated customer inquiries as required.
  • Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.
  • Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests. Escalate where necessary in accordance with claims guidelines and procedures.
  • Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.
  • Provide backup for any support functions.
  • Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.
  • Accomplishes company goals by taking ownership of work responsibilities and constantly identify opportunities for work process improvement.
  • Ensure legal compliance by following company policies, procedures, guidelines ad well as local insurance regulations and statute.
  • Adhere to strict data protection protocols by keeping claims and sensitive medical information highly confidential.
Job Type: Full-time
Pay: Php30,000.00 - Php40,000.00 per month
Benefits:
  • Opportunities for promotion
  • Promotion to permanent employee
Schedule:
  • 8 hour shift
  • Day shift
  • Monday to Friday
Supplemental Pay:
  • 13th month salary
  • Overtime pay
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