Claims Analsyt (Healthcare)

Key Responsibilities

• Receives batches of claim transactions.
• Adjudicates claims based on the Schedule of Benefits, claims protocols, and government regulations.
• Operates the Claims System accurately and efficiently to ensure timely recording of claims information.
• Follows up with clients to ensure all supporting documents and information required for claim assessments are obtained promptly.
• Responds to claims inquiries, feedback, and complaints promptly and effectively.
• Monitors personal productivity to meet individual and team performance targets.
• Ensures proper filing and organization of all claim's documents.
• Performs other ad hoc tasks assigned by superiors as needed.

Qualifications

• Must possess at least a Diploma, Advanced/Higher/Graduate Diploma, Bachelor's
• Degree, or Professional Certificate in Insurance or a related field.
• Technical knowledge of medical claims or relevant experience in the HMO, Third-
• Party Administrator (TPA), or insurance industry is a major advantage.
• Excellent verbal and written communication skills in both English and Tagalog.
• Ability to work in a fast-paced environment both independently and with a customer-
• focused, proactive attitude and a strong sense of responsibility.
• Proficient in computer applications, specifically Microsoft Office (Word, Excel, etc.).
• Flexible and willing to work extended hours when required.