- Competitive rewards with 13th and 14th month pay
- Comprehensive health insurance including life insurance and accident insurance
- Annual medical allowance to support wellness needs
- Generous leave entitlements: vacation leave, sick leave, and emergency leave
Duties and Responsibilities
- Checks availability and accuracy of claims details in MAS
- Makes necessary corrections of claims details
- Verifies unlisted claims in MAS with biller and Call Center
- 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
- Conduct UAT of system enhancements
- Provide analysis and findings on the UAT done
- Coordinate with ITG on the findings
- 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
Qualifications
- College graduates 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
Senior Claims Specialist
Operations
Hybrid (3x onsite, 2x Work from Home/Anywhere every week)
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Bachelor's degree in medical or business discipline, LOMA courses preferred
Claims processing, Medical knowledge, Customer service
Check availability and accuracy of claims details in MAS., Make necessary corrections of claims details., Verify unlisted claims in MAS with biller and Call Center., Process and analyze claims using the prescribed process and based on existing policy contract and guidelines., Prepare transmittal of claims for payment., Approve payment for claims within the authority limit., Recommend approval of claims payment beyond authority limit., Reconcile claims with providers/accounts., Conduct UAT of system enhancements., Provide analysis and findings on the UAT done., Coordinate with ITG on the findings., 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.