11 Claims Processing jobs in the Philippines

Claims Processor

Makati, National Capital Region Dempsey Resource Management Inc.

Posted 7 days ago

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Job Description

URGENT HIRING! This might be your opportunity if you meet the qualifications below:
br>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:

⦁ -2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries. < r>⦁ F miliarity with medical billing and reimbursement processes. < r>⦁ E perience working with HMO procedures and healthcare provider networks is a plus. < r>
Skills:
⦁ A tention to Details: Accurate and thorough in reviewing medical claims, documents, and codes. < r>⦁ A alytical Thinking: Ability to interpret policy coverage, medical reports, and supporting documents to identify discrepancies or irregularities. < r>⦁ C mmunication: Strong written and verbal communication skills to coordinate with hospitals, clinics, and policyholders. < r>⦁ T chnical Proficiency: Proficient in medical claims processing systems, Microsoft Excel, MS Word, and email platforms. < r>⦁ P oblem-solving: Capable of investigating claims issues and resolving them in a timely and efficient manner. < r>
Other Qualifications:

⦁ F miliarity with ICD, CPT, and HCPCS codes and medical terminology. < r>⦁ K owledge of insurance guidelines, HMO processes, and regulatory compliance. < r>⦁ A ility to multitask and work efficiently under time constraints. < r>⦁ E cellent organizational and documentation skills. < r>
Job Specifications:

Claims Processing:

⦁ R view and process medical claims submitted by members or healthcare providers. < r>⦁ C eck documents for completeness, including medical abstracts, itemized statements, and official receipts. < r>⦁ V rify member eligibility, benefits coverage, and policy limits. < r>⦁ A ply appropriate coding and benefits computation based on the member’s plan and HMO rules.
⦁ E code claims data into the medical claims processing system. < r>⦁ M intain updated records of approved, denied, and pending claims. < r>⦁ D cument any adjustments, follow-ups, and discrepancies. < r>
Claims Evaluation:

⦁ E aluate claims against policy provisions and clinical guidelines. < r>⦁ D tect potential fraud, abuse, or claim duplication. < r>⦁ C ordinate with medical providers to validate unclear or questionable claims. < r>⦁ A curately calculate payable amounts, co-pays, and exclusions. < r>
Work Schedule: Monday to Friday
Working Hours: 8:30 am to 5:30 pm
Work Location: Makati Office
This advertiser has chosen not to accept applicants from your region.

Claims Analyst

Manulife

Posted 4 days ago

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Job Description

_We're looking for a_ **Claims Analyst** _to join our Insurance Operations team at MBPS. In this role, you are expected to process number of worktypes that has TAT requirements of Day 0, 2, 15, 30 and so on._
**Position Responsibilities:**
+ Create death benefit packages and send correspondence via fax, mail, or email to obtain missing documents.
+ Report any overpayments, underpayments, and other financial irregularities related to claims.
+ Process high-priority claims transactions, including settlements, policy closures, asset freezing, and notifying beneficiaries of settlement requirements.
+ Identify transactions that need to be forwarded to the appropriate business unit or other departments and teams.
+ Investigate, evaluate, and settle claims using technical knowledge to ensure fair and prompt case resolution and contribute to a reduced loss ratio.
**Required Qualifications:**
+ College/University graduate, preferably with experience in the financial services or call center industry and demonstrated service aptitude.
+ Advanced knowledge of MS Word and Excel, basic computer literacy, and telephony skills.
+ Excellent written and verbal communication skills, strong customer service skills, problem-solving abilities, and a minimum typing speed of 30 words per minute. Ability to work independently and identify business process improvements.
+ Amenability to work in fixed night shift
**Preferred Qualifications:**
+ Intermediate product knowledge of Retail/Fixed products.
+ Ability to differentiate Retail/Fixed Annuities work types and processes.
+ Average knowledge in Retail Annuities Claims processes.
+ Familiarity with effective internal control procedures.
+ Intermediate knowledge of Retail/Fixed Annuities systems, applications, and tools.
**_When you join our team:_**
+ We'll empower you to learn and grow the career you want.
+ We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
+ As part of our global team, we'll support you in shaping the future you want to see.
**Acerca de Manulife y John Hancock**
Manulife Financial Corporation es un importante proveedor internacional de servicios financieros que ayuda a las personas a tomar decisiones de una manera más fácil y a vivir mejor. Para obtener más información acerca de nosotros, visite .
**Manulife es un empleador que ofrece igualdad de oportunidades**
En Manulife/John Hancock, valoramos nuestra diversidad. Nos esforzamos por atraer, formar y retener una fuerza laboral tan diversa como los clientes a los que prestamos servicios, y para fomentar un entorno laboral inclusivo en el que se aprovechen las fortalezas de las culturas y las personas. Estamos comprometidos con la equidad en las contrataciones, la retención de talento, el ascenso y la remuneración, y administramos todas nuestras prácticas y programas sin discriminación por motivos de raza, ascendencia, lugar de origen, color, origen étnico, ciudadanía, religión o creencias religiosas, credo, sexo (incluyendo el embarazo y las afecciones relacionadas con este), orientación sexual, características genéticas, condición de veterano, identidad de género, expresión de género, edad, estado civil, estatus familiar, discapacidad, o cualquier otro aspecto protegido por la ley vigente.
Nuestra prioridad es eliminar las barreras para garantizar la igualdad de acceso al empleo. Un representante de Recursos Humanos trabajará con los solicitantes que requieran una adaptación razonable durante el proceso de solicitud. Toda la información que se haya compartido durante el proceso de solicitud de adaptación se almacenará y utilizará de manera congruente con las leyes y las políticas de Manulife/John Hancock correspondientes. Para solicitar una adaptación razonable en el proceso de solicitud, envíenos un mensaje a .
**Modalidades de Trabajo**
Híbrido
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Claims Verification Analyst

Manulife

Posted today

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Job Description

**_Are you looking for a supportive, collaborative workplace with great teams and inspiring leaders? You’ve come to the right place. We’re looking for ambitious people who share our values and want to make every day better for people around the world. If this sounds like you, and the career below sounds exciting, we’d like to hear from you. _**

**Working Arrangement**

Hybrid

**The Opportunity**

The customer is the focus of everything we do, and millions of end users rely on our products daily. We believe in the value of empowering Business Process Associates with the resources to solve critical problems for the future of our business, which is why we need you.

**We are looking for someone with**:

- **Education**: High School/Senior High/Vocational Course/1 yr completed in a Bachelor's program with relevant work experience of at least 2 years; Bachelor's Degree holders are welcome to apply
- **Experience**: NONE required for Bachelor's Degree holders; At least two years of relevant experience for college undergraduates
- **Schedule**:Amenability to work on shifting schedules, weekends and Philippine holidays (when needed)
- **Location**: Amenability to work in UP Ayalaland Technohub, Quezon City
- HYBRID Work Arrangement - amenability and readiness to work onsite and from home anytime (dependent on business needs AND/OR current external environment/situation)

**On the job you will**:

- Validates plan member’s online claim submission by reviewing receipts and any supporting documents as well as conducting phone calls.
- Verifies provider registration or license through websites or phone call to regulatory bodies
- Consistently meet or exceed accuracy, productivity, and TAT standards.
- Collaborates with Claim Department to guarantee correct reimbursement
- Coordinate with Business Unit counterpart to resolve on-the-spot process clarifications and gaps

**What motivates you?**
- You obsess about customers, listen, engage and act for their benefit.
- You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
- You thrive in teams and enjoy getting things done together.
- You take ownership and build solutions, focusing on what matters.
- You do what is right, work with integrity and speak up.
- You share your humanity, helping us build a diverse and inclusive work environment for everyone.

**What can we offer you?**
- A competitive salary and benefits packages.
- A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
- A focus on growing your career path with us.
- Flexible work policies and strong work-life balance.
- Professional development and leadership opportunities.

**Our commitment to you**
- Values-first culture
We lead with our Values every day and bring them to life together.
- Boundless opportunity
We create opportunities to learn and grow at every stage of your career.
- Continuous innovation
We invite you to help redefine the future of financial services.
- Delivering the promise of Diversity, Equity and Inclusion
We foster an inclusive workplace where everyone thrives.
- Championing Corporate Citizenship
We build a business that benefits all stakeholders and has a positive social and environmental impact.

**About John Hancock and Manulife**

**Manulife is an Equal Opportunity Employer
This advertiser has chosen not to accept applicants from your region.

NY Independent Adjuster for Insurance Claims - Pasay City

Pasay, National Capital Region TASQ Staffing Solutions

Posted 1 day ago

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Job Description

About the job: NY Adjuster—New York Independent Adjuster for Insurance Claims (Pasay) | Onsite
Shift: Mon-Fri, night shift (Shift starts anytime between 8:00 pm and 12:00 pm) br>
Work setup: Onsite (MOA Pasay)

Good-to-Haves:

Experience in L&A Insurance

Requirements:

Active NY Independent Adjuster License Series 17-63
The license should be active for at least 1 year and 6 months from the company join date
1-year claims adjudication work experience at the minimum
Educational Attainment:

Finished at least 2 years in college if new curriculum
College graduate if old curriculum
This advertiser has chosen not to accept applicants from your region.

NY Independent Adjuster for Insurance Claims - Cebu City

Cebu, Cebu TASQ Staffing Solutions

Posted 1 day ago

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Job Description

About the job: NY Adjuster—New York Independent Adjuster for Insurance Claims (Cebu) | Onsite
Shift: Mon-Fri, night shift (Shift starts anytime between 8:00 pm and 12:00 pm) br>
Work setup: Onsite (Cebu)

Good-to-Haves:

Experience in L&A Insurance
Requirements:

Active NY Independent Adjuster License Series 17-63
The license should be active for at least 1 year & 6 months from the company join date
1-year claims adjudication work experience at the minimum
Educational Attainment:

Finished at least 2 years in college if new curriculum
College graduate if old curriculum
This advertiser has chosen not to accept applicants from your region.

Insurance / Claims Analysts - (Onsite)

Cebu, Cebu Staff Outsourcing Solutions

Posted 6 days ago

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Job Description

REQUIREMENTS:
br>Experience working as a representative of the providers or members line for queries in eligibility and benefits, claims, and authorizations.
Preferably with experience in inpatient or outpatient services.
Must know the basic insurance terms.
Knowledge in Medical Billing/Claims.
Experience in Revenue Cycle Management (or a part of) required.
The job will be a mix of insurance payment collections, reports generation and phone calls (only 10% calls, or maybe less!).
Basic knowledge in Word and Excel is required. Knowledge in Google sheet a plus.

JOB RESPONSIBILITIES:

- Follow-Up with Insurance Carriers via all mediums to determine reason for claims denial and work to resolve medical claims for payment.
- Research problem accounts to ensure accuracy
- Ability to resolve insurance denials and file appeals with government and commercial carriers.
- Analyze the unpaid medical claims and denials and identify/investigate the reasons for nonpayment and which action is needed to resolve timely.
- Adheres to applicable policies, hospital/physician billing/departmental practices and 3rd party requirements.
- Denial Management--analyzing and resolving denied claims. Investigate the reasons for denials, identify errors or discrepancies, and take corrective actions, such as submitting appeals

EXCITING PERKS for successful hires.
Earn 40k up to 65k per month
This is an office-based position located in Cebu Business Park.
Work hours will be US Eastern time. FIXED WEEKENDS OFF.


STAFF OUTSOURCING SOLUTIONS
This advertiser has chosen not to accept applicants from your region.

Insurance / Claims Analysts - Start ASAP Cebu City

Cebu, Cebu Staff Outsourcing Solutions

Posted 12 days ago

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Job Description

REQUIREMENTS:
br>Experience working as a representative of the providers or members line for queries in eligibility and benefits, claims, and authorizations.
Preferably with experience in inpatient or outpatient services.
Must know the basic insurance terms.
Knowledge in Medical Billing/Claims.
Experience in Revenue Cycle Management (or a part of) required.
The job will be a mix of insurance payment collections, reports generation and phone calls (only 10% calls, or maybe less!).
Basic knowledge in Word and Excel is required. Knowledge in Google sheet a plus.

JOB RESPONSIBILITIES:

- Follow-Up with Insurance Carriers via all mediums to determine reason for claims denial and work to resolve medical claims for payment.
- Research problem accounts to ensure accuracy
- Ability to resolve insurance denials and file appeals with government and commercial carriers.
- Analyze the unpaid medical claims and denials and identify/investigate the reasons for nonpayment and which action is needed to resolve timely.
- Adheres to applicable policies, hospital/physician billing/departmental practices and 3rd party requirements.
- Denial Management--analyzing and resolving denied claims. Investigate the reasons for denials, identify errors or discrepancies, and take corrective actions, such as submitting appeals

EXCITING PERKS for successful hires.
Earn 40k up to 65k per month
This is an office-based position located in Cebu Business Park.
Work hours will be US Eastern time. FIXED WEEKENDS OFF.

If you are interested please submit your updated resume to

STAFF OUTSOURCING SOLUTIONS
This advertiser has chosen not to accept applicants from your region.
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Claims Assistant (Insurance)

National Capital Region, National Capital Region WHR Global Consulting

Posted 6 days ago

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Job Description

POSITION TITLE: Claims Assistant (Non-motor Insurance)
WORK LOCATION: Alabang br> WORK SETUP: Onsite always
WORK SCHEDULE: Day Shift

QUALIFICATIONS:
-Graduate of any 4-year bachelor’s degree. < r> -2–4 years experience in Non-Motor Claims or prior experience in a claims department or working with insurance claims is a significant advantage. < r> -Experience in handling properties, cargo, and OFW-related accounts.
-Prior administrative or customer service experience, preferably in insurance, healthcare, or financial services.
-Strong organizational and multitasking skills.
-Strong analytical capabilities.
-Proficient in Microsoft Office Suite (Excel, Word, etc.) and familiarity with claims management software.
-Attention to detail and high level of accuracy.
-Strong communication skills, both written and verbal.
-Ability to handle confidential information with discretion.
-Team-oriented and proactive in assisting other claims staff.

JOB SUMMARY/DESCRIPTION:
Provides administrative support in the claims process by assisting with preparation, documentation, and communication involved in handling claims. Ensures smooth and efficient claims processing, supporting claimants and internal teams in various claims management tasks.

RESPONSIBILITIES/DUTIES:
-Input claim data into the system, ensuring accuracy, completeness, and proper filing.
-Assist in collecting and organizing necessary documentation for claims, including medical reports, receipts, and forms.
-Analyze claims data to identify discrepancies, fraud, or errors and escalate complex claims to senior staff or managers.
-Conduct initial investigations to gather additional information or verify claim details when necessary.
-Assist in negotiation or determination of appropriate settlements within guidelines.
-Follow up with clients, healthcare providers, or third parties to ensure documentation is received for timely claim resolution.
-Communicate with clients, vendors, adjusters, and internal departments for information requests or clarifications.
-Answer inquiries from claimants or policyholders regarding claim status, documentation, and timelines; provide updates as needed.
-Maintain accurate and organized physical or electronic files for each claim.
-Ensure compliance with industry regulations, company policies, and procedures related to claims.
-Provide general administrative support such as scheduling meetings and preparing claim-related reports.
-Assist in preparing reports on claims processing performance or trends for management.
This advertiser has chosen not to accept applicants from your region.

Claims Manager - Life Insurance

Makati, National Capital Region Career Professionals Inc.

Posted today

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Job Description

Overall efficiency of day-to-day operations of Claims Unit
- Team performance and development
- Availability of claims data and reports needed for management decision making, process improvement or compliance

with reporting requirements
- Meeting needs of customers (internal or external) by addressing or resolving customer needs or concerns in a prompt

and professional manner

**Salary**: Up to Php85,000.00 per month

**Benefits**:

- Additional leave
- Health insurance
- Life insurance
- Work from home

Schedule:

- 8 hour shift

Supplemental pay types:

- 13th month salary
- Anniversary bonus
- Bonus pay

Application Question(s):

- Availability for employment?
- Expected salary?
- Age and Civil status?

**Education**:

- Bachelor's (required)

**Experience**:

- claims administration: 3 years (required)
- managerial/supervisory: 1 year (required)
- insurance industry working: 3 years (required)
This advertiser has chosen not to accept applicants from your region.

Claims Assistant (Non-motor Insurance)

National Capital Region, National Capital Region WHR Global Consulting

Posted 5 days ago

Job Viewed

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Job Description

POSITION TITLE: Claims Assistant (Non-motor Insurance)
WORK LOCATION: Alabang br> WORK SETUP: Onsite always
WORK SCHEDULE: Day Shift

QUALIFICATIONS:
-Graduate of any 4-year bachelor’s degree. < r> -2–4 years experience in Non-Motor Claims or prior experience in a claims department or working with insurance claims is a significant advantage. < r> -Experience in handling properties, cargo, and OFW-related accounts.
-Prior administrative or customer service experience, preferably in insurance, healthcare, or financial services.
-Strong organizational and multitasking skills.
-Strong analytical capabilities.
-Proficient in Microsoft Office Suite (Excel, Word, etc.) and familiarity with claims management software.
-Attention to detail and high level of accuracy.
-Strong communication skills, both written and verbal.
-Ability to handle confidential information with discretion.
-Team-oriented and proactive in assisting other claims staff.

JOB SUMMARY/DESCRIPTION:
Provides administrative support in the claims process by assisting with preparation, documentation, and communication involved in handling claims. Ensures smooth and efficient claims processing, supporting claimants and internal teams in various claims management tasks.

RESPONSIBILITIES/DUTIES:
-Input claim data into the system, ensuring accuracy, completeness, and proper filing.
-Assist in collecting and organizing necessary documentation for claims, including medical reports, receipts, and forms.
-Analyze claims data to identify discrepancies, fraud, or errors and escalate complex claims to senior staff or managers.
-Conduct initial investigations to gather additional information or verify claim details when necessary.
-Assist in negotiation or determination of appropriate settlements within guidelines.
-Follow up with clients, healthcare providers, or third parties to ensure documentation is received for timely claim resolution.
-Communicate with clients, vendors, adjusters, and internal departments for information requests or clarifications.
-Answer inquiries from claimants or policyholders regarding claim status, documentation, and timelines; provide updates as needed.
-Maintain accurate and organized physical or electronic files for each claim.
-Ensure compliance with industry regulations, company policies, and procedures related to claims.
-Provide general administrative support such as scheduling meetings and preparing claim-related reports.
-Assist in preparing reports on claims processing performance or trends for management.
This advertiser has chosen not to accept applicants from your region.
 

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