77 Claims Specialist jobs in the Philippines

POSITION OVERVIEW

Claims Processors are involved in managing a claim from beginning through to settlement. They ensure that claims are handled efficiently and that payment for valid claims is made to their policyholders. Claims Processors decide on the extent and validity of a claim by checking for any potential fraudulent activity. They liaise with external experts such as loss adjusters and lawyers and may be involved in legal discussions about the recovery of money from the party responsible for the loss. Claims Processors do much more than simply fill out paperwork. They have to analyze the data that they are given to recommend an informed decision and keep with their company's standards

POSITION DESCRIPTION

• Interact with customers and act as a liaison between clients and companies by providing information to address inquiries regarding products and services
• Assist and help resolve any client inquiries, errors, account questions, billing, cancelations, and other queries about products and services
• Answer questions, offer advice, resolve routine problems in service, and serve as advocates for client's customer service brand
• Process new Claims policies, modify existing ones and obtain information from policyholders to verify the accuracy of their accounts
• Calculate the amounts of claims, apply rating systems to claims, contact people involved in claims to obtain relevant information and recommend claim actions
• Assist claimants, providers and clients with problems or questions regarding their claims and/or policies whilst complying with state laws, policy and company procedures
• Listening attentively to customer needs and concerns; demonstrate empathy while maximizing opportunity to build rapport with the customer
• Confirm customer understanding of the solution and provide additional customer education as needed
• Make follow up outbound calls to customers and other parties as a part of case resolution process
• Ensure all client enquiries are recorded into the system, confirming all contact details of the enquirer with 100% accuracy
• Reviews claims thoroughly and to makes sure that all information are complete and correct; updates records of claims and follow up on lapsed cases
• Provide well-rounded, prompt, high-quality, and professional client service at all times
• Any other task/duty as directed by client/management

POSITION REQUIREMENTS

• Candidate must possess at least an Associate's or Bachelor's/College Degree
• With at least 2 years of work experience in a similar role
• Proficient in using Microsoft Office applications and is tech savvy
• Previous experience in the healthcare industry is an advantage
• Ability to be flexible, adaptable and adjust in a fast-paced work environment
• Excellent command of the English language, and is an effective communicator both orally and written
• Strong customer service orientation and people skills
• Must have patience, empathy and self-control to deal with angry, emotional or frustrated clients
• High critical thinking skills such as reasoning, logic and judgment to solve a variety of coverage-related issues

The Claim Specialist is responsible for the timely and accurate adjudication of pre-booked and registered claims, including verifying cargo discrepancies, evaluating documentation, issuing necessary reports and notices, coordinating with Finance for settlements, and recommending process improvements. Ensures claims are processed within established timelines and maintains proper records for future reference.

The ideal candidate for the role is a graduate of any 4-year course with proficiency in MS Word, Excel, and PowerPoint. Possesses a teachable attitude, strong attention to detail, initiative, and good interpersonal and teamwork skills.

Why join us?

Joining our team means being part of a dynamic and growing organization that values Excellence, Customer Delight, Commitment, Innovation, and Teamwork.

We offer a supportive work environment where your skills and ideas are recognized and rewarded. With opportunities for professional development. Be part of a company that invests in its people and fosters a culture of excellence and integrity.

About FAST Logistics Group

With 50 years of experience, FAST stands at the forefront of end-to-end logistics and supply chain management in the Philippines. Leveraging their extensive network, they provide a comprehensive range of solutions, encompassing transport, warehousing, and selling distribution. FAST operates the largest warehouse footprint in the country, the largest fleet of trucking transport, and the widest selling and distribution network, with over 13,000 employees covering 94% of the country's provinces.

With a tech-forward mindset, FAST continues to pioneer innovation and solutions in all facets of Philippine logistics, ensuring that everything they do is future-proofed and continuously advancing.

For more information, visit

Job Types: Full-time, Permanent, Fresh graduate

Benefits:

• Additional leave
• Company Christmas gift
• Health insurance
• Life insurance
• Opportunities for promotion
• Promotion to permanent employee

Education:

• Bachelor's (Required)

Work Location: In person

Role and Responsibilities

1. Responsible for coordinating and supporting initiatives relative to the evaluation, processing, and handling of insurance claims

2. Liaises with concerned parties to gather all pertinent documents for processing of claims

3. Reviews the status and eligibility of claims and makes recommendations for resolutions as needed.

4. Proactively coordinate the processing of insurance claims

Qualifications and Education

1. Bachelor's degree in Engineering, Accounting, or Business Management.

2. With experience handling insurance claims such as CARI

3. With relevant experience in liaison and coordination regarding insurances and claims

4. Excellent communication and documentation skills

Job Type: Full-time

Pay: Php25, Php30,000.00 per hour

Expected hours: 40 per week

Work Location: In person

POSITION OVERVIEW

Claims Processors are involved in managing a claim from beginning through to settlement. They ensure that claims are handled efficiently and that payment for valid claims is made to their policyholders. Claims Processors decide on the extent and validity of a claim by checking for any potential fraudulent activity. They liaise with external experts such as loss adjusters and lawyers and may be involved in legal discussions about the recovery of money from the party responsible for the loss. Claims Processors do much more than simply fill out paperwork. They have to analyze the data that they are given to recommend an informed decision and keep with their company's standards

POSITION DESCRIPTION

• Interact with customers and act as a liaison between clients and companies by providing information to address inquiries regarding products and services
• Assist and help resolve any client inquiries, errors, account questions, billing, cancelations, and other queries about products and services
• Answer questions, offer advice, resolve routine problems in service, and serve as advocates for client's customer service brand
• Process new Claims policies, modify existing ones and obtain information from policyholders to verify the accuracy of their accounts
• Calculate the amounts of claims, apply rating systems to claims, contact people involved in claims to obtain relevant information and recommend claim actions
• Assist claimants, providers and clients with problems or questions regarding their claims and/or policies whilst complying with state laws, policy and company procedures
• Listening attentively to customer needs and concerns; demonstrate empathy while maximizing opportunity to build rapport with the customer
• Confirm customer understanding of the solution and provide additional customer education as needed
• Make follow up outbound calls to customers and other parties as a part of case resolution process
• Ensure all client enquiries are recorded into the system, confirming all contact details of the enquirer with 100% accuracy
• Reviews claims thoroughly and to makes sure that all information are complete and correct; updates records of claims and follow up on lapsed cases
• Provide well-rounded, prompt, high-quality, and professional client service at all times
• Any other task/duty as directed by client/management

POSITION REQUIREMENTS

• Candidate must possess at least an Associate's or Bachelor's/College Degree
• With at least 2 years of work experience in a similar role
• Proficient in using Microsoft Office applications and is tech savvy
• Previous experience in the healthcare industry is an advantage
• Ability to be flexible, adaptable and adjust in a fast-paced work environment
• Excellent command of the English language, and is an effective communicator both orally and written
• Strong customer service orientation and people skills
• Must have patience, empathy and self-control to deal with angry, emotional or frustrated clients
• High critical thinking skills such as reasoning, logic and judgment to solve a variety of coverage-related issues

You'll be responsible for verifying insurance eligibility and authorization for virtual psychotherapy. Your role will involve accurate documentation, timely re-authorization checks, and effective communication with payers and team members.

• Verify insurance eligibility and authorization accurately and promptly
• Document calls as per training guidelines and report issues urgently
• Enter authorization and eligibility information
• Communicate changes in authorization to management
• Ensure all client authorizations are current and meet payer requirements
• Maintain professional and positive communication with payers, clients, and team members
• Uphold confidentiality of client and employee information

• Strong attention to detail and organizational skills
• Excellent communication and problem-solving abilities
• Ability to work efficiently and prioritize tasks independently

We specialize in delivering innovative solutions and exceptional services to meet the diverse needs of our clients. With a strong commitment to quality and customer satisfaction, we strive to exceed expectations and drive success in every project we undertake.

• Position
  : Claims Assistant (Non-motor Insurance)
• Location
  : Alabang, Muntinlupa City
• Setup
  : Onsite
• Schedule
  : Day Shift

Qualifications:

• Graduate of any 4-year bachelor's degree.
• 2 – 4 years of experience in Non-Motor Claims or prior experience in a claims department or working with insurance claims is a significant advantage.
• Experience in handling properties, cargo, and OFW-related accounts.
• Prior administrative or customer service experience in insurance, healthcare, or financial services.
• Proficient in Microsoft Office Suite (Excel, Word, etc.) and familiar with claims management software.
• Strong communication skills, both written and verbal.
• Ability to handle confidential information with discretion.
• Team-oriented and proactive in assisting other claims staff.

Responsibilities:

• 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.

ISTA Solutions, an outsourcing/offshoring company, is in search of an experiencedClaims Specialist to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you

• Access and retrieve claim information through various medical billing portals
• Contact insurance companies or patients via phone when necessary to follow up on claims
• Accurately input data into a live spreadsheet.
• Ensure timely and accurate submission and follow-up of medical claims
• Collaborate with team members to identify billing issues and resolve them

• At least 6 months BPO experience handling US Healthcare Insurance
• Must have experience with Claims
• Strong problem-solving skills
• Adaptability to a changing work environment
• Ability to remain calm under pressure
• Good verbal and written English skills
• Willing to work onsite in Mandaluyong
• Amenable working night shifts

What can we offer you?

• Competitive salary and benefits
• Health Insurance with free dependents*
• 10%-night differential
• Attendance Bonus
• Paid time off
• Convertible to cash leave credits
• Performance Appraisal
• Work-life balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our commitment to you

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all inclusive environment where everyone thrives