1. CLAIMS PROCESSING

• Ensures accurate review of claims document like LOA, hospital bills/SOA, concurrent review form, physician’s report, original OR for use in processing claims.

2. CLAIMS REVIEW/ EVALUATION/ ADJUDICATION

• Reviews/evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards

3. CLAIMS APPROVAL

• Approves claims according to limits of authority.

4. CUSTOMER SERVICE

• Ensures provision of quality customer service
• Maintains good relationships with providers by making regular visits and ensuring timely payment of medical bills, in coordination with other departments.
• Handles inquiries of clients, members and agents regarding application for claims, including handling complaints.

5. ADMINISTRATIVE RESPONSIBILITIES

• Undertakes Administrative Responsibilities to ensures proper filing of claims documentation and booking them

• 4 year graduate of any course
• With experience as Claims Processor (Preferably Supervisory level)
• Willing to work in Makati
• Can start ASAP