Claim Processor

Monthly Salary: PHP 18,000
Work Schedule: Monday to Friday
Working Hours: 8:30 am to 5:30 pm
Work Location: Makati Office

Job Qualifications:

Educational Background:
Bachelor’s degree in Business administration, Healthcare Management, Nursing, or a related field is preferred.
A diploma in medical, healthcare, or business-related field may be considered.
Experience:
1-2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries.
Familiarity with medical billing and reimbursement processes.
Experience working with HMO procedures and healthcare provider networks is a plus.
Skills:
Attention to Details: Accurate and thorough in reviewing medical claims, documents, and codes.
Analytical Thinking: Ability to interpret policy coverage, medical reports, and supporting documents to identify discrepancies or irregularities.
Communication: Strong written and verbal communication skills to coordinate with hospitals, clinics, and policyholders.
Technical Proficiency: Proficient in medical claims processing systems, Microsoft Excel, MS Word, and email platforms.
Problem-solving: Capable of investigating claims issues and resolving them in a timely and efficient manner.
Other Qualifications:
Familiarity with ICD, CPT, and HCPCS codes and medical terminology.
Knowledge of insurance guidelines, HMO processes, and regulatory compliance.
Ability to multitask and work efficiently under time constraints.
Excellent organizational and documentation skills.