Claims Processor - Urgent
Makati, National Capital Region
Posted 23 days ago
- Company:
- Dempsey Resource Management Inc.
- Company Description:
- Dempsey Resource Management Inc. (DEMPSEY) is a Philippine-based executive search and referral services company specializing in sourcing competent and qualified candidates for direct hiring by client companies. Unlike contracting agencies, DEMPSEY does not hire or deploy personnel for contractual, temporary, or project-based roles. Established in 2008 and headquartered in Quezon City, DEMPSEY is duly registered with the Department of Labor and Employment, Securities and Exchange Commission, Bureau of Internal Revenue, and holds the necessary business permits. The company focuses on matching private companies with professionals across various fields, including Accounting, Finance, Engineering, Sales, Marketing, Web Development, Human Resources, and Behavioral Sciences. DEMPSEY sources candidates from both Metro Manila and provincial institutions, aiming to provide opportunities that hone natural talents, enhance acquired skills, and maximize potential for efficient, productive, and successful employment.
- Contract Type:
- Full Time
- Experience Required:
- 1 year
- Education Level:
- Bachelor’s Degree
- Number of vacancies:
- 1
Job Description
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.
Job Specifications:
Claims Processing:
Review and process medical claims submitted by members or healthcare providers.
Check documents for completeness, including medical abstracts, itemized statements, and official receipts.
Verify member eligibility, benefits coverage, and policy limits.
Apply appropriate coding and benefits computation based on the member’s plan and HMO rules.
Data Entry & Record Keeping:
Encode claims data into the medical claims processing system.
Maintain updated records of approved, denied, and pending claims.
Document any adjustments, follow-ups, and discrepancies.
Claims Evaluation:
Evaluate claims against policy provisions and clinical guidelines.
Detect potential fraud, abuse, or claim duplication.
Coordinate with medical providers to validate unclear or questionable claims.
Accurately calculate payable amounts, co-pays, and exclusions.
NOTE: THIS IS DIRECT HIRE AND NOT UNDER AGENCY
