Business Unit: Maxicare
Level: Rank and File
Reporting Line: Finance Supervisor
Position Accountability Statement
This role is focused on the integrity of the HMO's core financial obligations, centered primarily around its largest liability: medical claims. This analyst acts as the vital bridge between the Operational Claims System and the General Ledger (GL)—ensuring that what the HMO owes to hospitals, doctors, and members is perfectly reconciled and accrued—while also maintaining strict oversight and review of all other operational payable schedules to guarantee comprehensive ledger accuracy.
Job Description
- Claims System vs. GL Reconciliation
- Perform daily/weekly reconciliations between the operational claims processing system and the accounting General Ledger.
- Identify, track, and resolve system-to-ledger timing differences or data transmission gaps.
- Liability Accruals & Actuarial Coordination
- Calculate and post monthly accruals for unpaid claims and capitation fees.
- Collaborate closely with the Actuarial Team to ensure accurate reporting and adjustment of IBNR (Incurred But Not Reported) reserves.
- Discrepancy Resolution
- Investigate variances regarding overpayments, underpayments, rejected claims, and doublebillings.
- Partner with the Claims Operations team to resolve systemic errors and streamline billing accuracy.
- Liability & Sub-Ledger Review (New Focus)
- Regularly review and reconcile GL schedules with respect to other payable accounts to ensure proper classification and completeness.
- Monitor sub-ledgers for miscellaneous liabilities, vendor payables, or non-claim operational expenses to maintain overall ledger health.
- Aging Reports & Liquidity Management
- Maintain and analyze aging schedules for claims and other liabilities to ensure timely payouts and avoid provider or vendor disruptions.
- Highlight overdue items or critical aging thresholds to management for cash flow planning.
STANDARD RESPONSIBILITY STATEMENTS
- Strives to embody, commits to support, and deliver the quality policy, objectives and initiatives of the organization;
- Communicates, engages, directs, and supports people to contribute to the QMS effectiveness;
- Demonstrates commitment to customers by ensuring applicable statutory and regulatory
requirements are determined, understood and consistently met;
- Abides by the QMS policies and procedures for the effective management and control of its processes; and
- Promotes and utilizes the Process Approach and Risk-based Thinking at work.
- Performs other RELATED functions that may be assigned BY THE IMMEDIATE SUPERIOR
Qualifications
Bachelor's degree in Accountancy
CPA designation is an advantage but not required
Strong knowledge of accounting principles and financial reporting standards (e.g., PFRS/IFRS).
Proficient in Microsoft Excel; knowledge of Oracle Cloud ERP is an advantage.
Experience in the insurance or financial services industry is an advantage
