Medical Claims Analyst

1-3 Years

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Early Applicant

Job Description

Assure accurate insurance claims adjudication in a timely manner.
Assure timely submission of invoices/claims utilization report.
Validate documents received as well as members information to adjudicate the claims based on the submitted information.
Apply the Plan policy and its exclusion as well as underwriting guidelines to determine coverage for claims.
Deny claims according to SOB, exclusions, and policies.
Assure timely payment of invoices from providers and ensure all information and documents needed are accurate and complete.
Keep management aware of members issues from providers to enhance operations and escalate to the higher-ups when necessary.
Coordinate with providers all Claims unpaid and do reconciliation.
Answer inquiries and handle complaints from providers.

Top Benefits Or Perks

The country's best medical coverage for you and your family, with an annual limit of 100,000 USD (almost 6,000,000 PHP) per insured member.
Profit sharing (0-4 months extra salary per year performance-basedpotential of 100K).
Flexible hybrid work set-up (1-10 days in the office per month).
Subsidized mobile plan (1,000 PHP).
Internet allowance (1,000 PHP).
1-time 20,000 PHP allowance for home office set-up.
Bachelor's degree in nursing or related course.
Registered Nurse is an advantage.
Thorough knowledge of the claims process in medical insurance with a minimum of 1 year of relevant experience.
Structured and organized.
Good oral and written English communication skills.