JOB PURPOSE:This job is responsible for the review, analysis and/or adjudication of claims incurred by eligible members of PhilCare to ensure that they are according to respective benefits plan, policies and standards and maintains the records system for these claims.
4 year graduate of any course
- Preferably with experience as Claims Processor
Willing to work in Makati- DUTIES AND RESPONSIBILITIES:
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
Approves claims according to limits of authority.
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
Job Type: Full-time
Pay: Php17,000.00 - Php20,000.00 per month
Schedule: Monday to Friday
Supplemental Pay:
* 13th month salary
