144 Healthcare Claims jobs in the Philippines

Healthcare Claims Specialist

Mandaluyong, National Capital Region ₱900000 - ₱1200000 Y ISTA Solutions

Posted today

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Job Description

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative 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
Account Specific Roles and Responsibilities:

  • Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements
  • Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns
  • Verify claim details including eligibility, coverage, and supporting documentation
  • Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication
  • Identify and escalate discrepancies, denials, and appeals as needed
  • Maintain accurate and timely claim records in line with company and client standards
  • Uphold confidentiality and compliance with HIPAA guidelines

Requirements

  • Above average verbal and written English communication skills
  • Healthcare experience is REQUIRED
  • Medical claims and prior authorization experience preferred but not required
  • Knowledge of medical and diagnosis codes is required
  • Strong attention to detail with a focus on accuracy
  • Ability to work independently while managing multiple tasks

Benefits
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
This advertiser has chosen not to accept applicants from your region.

Healthcare Claims Specialist

Mandaluyong, National Capital Region ₱900000 - ₱1200000 Y ISTA Personnel Solutions

Posted today

Job Viewed

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Job Description

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative 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

Account Specific Roles and Responsibilities:

  • Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements.
  • Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns.
  • Verify claim details including eligibility, coverage, and supporting documentation.
  • Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication.
  • Identify and escalate discrepancies, denials, and appeals as needed.
  • Maintain accurate and timely claim records in line with company and client standards.
  • Uphold confidentiality and compliance with HIPAA guidelines.
Requirements
  • At least 6 months of Healthcare experience.
  • Above average verbal and written English communication skills.
  • Medical claims and prior authorization experience preferred but not required.
  • Knowledge of medical and diagnosis codes is required.
  • Strong attention to detail with a focus on accuracy.
  • Ability to work independently while managing multiple tasks.
Benefits

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

Healthcare Claims Specialist

Mandaluyong, National Capital Region ₱900000 - ₱1200000 Y ISTA Solutions

Posted today

Job Viewed

Tap Again To Close

Job Description

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative 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
Account Specific Roles and Responsibilities:

  • Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements
  • Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns
  • Verify claim details including eligibility, coverage, and supporting documentation
  • Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication
  • Identify and escalate discrepancies, denials, and appeals as needed
  • Maintain accurate and timely claim records in line with company and client standards
  • Uphold confidentiality and compliance with HIPAA guidelines

Requirements

  • At least 6 months of Healthcare experience
  • Above average verbal and written English communication skills
  • Medical claims and prior authorization experience preferred but not required
  • Knowledge of medical and diagnosis codes is required
  • Strong attention to detail with a focus on accuracy
  • Ability to work independently while managing multiple tasks
  • Willing to work onsite in Mandaluyong
  • Amenable working night shift

Benefits
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
This advertiser has chosen not to accept applicants from your region.

Healthcare Claims Specialist

Mandaluyong, National Capital Region ₱900000 - ₱1200000 Y ISTA Personnel Solutions

Posted today

Job Viewed

Tap Again To Close

Job Description

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative 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

Account Specific Roles and Responsibilities:

  • Review and process ambulance insurance claims, ensuring accuracy and compliance with client and insurance requirements.
  • Work directly with clients to address inquiries, provide updates, and resolve claim-related concerns.
  • Verify claim details including eligibility, coverage, and supporting documentation.
  • Apply knowledge of medical and diagnosis codes to ensure correct claim submission and adjudication.
  • Identify and escalate discrepancies, denials, and appeals as needed.
  • Maintain accurate and timely claim records in line with company and client standards.
  • Uphold confidentiality and compliance with HIPAA guidelines.
Requirements
  • At least 6 months of Healthcare experience.
  • Above average verbal and written English communication skills.
  • Medical claims and prior authorization experience preferred but not required.
  • Knowledge of medical and diagnosis codes is required.
  • Strong attention to detail with a focus on accuracy.
  • Ability to work independently while managing multiple tasks.
  • Willing to work onsite in Mandaluyong
  • Amenable working night shift
Benefits

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

Healthcare Claims Representative

Makati, National Capital Region UnitedHealth Group

Posted 17 days ago

Job Viewed

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Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
**Primary Responsibilities:**
+ Provide expertise claims support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities
+ Analyze and identify trends and provides reports as necessary
+ Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
+ Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
**Required Qualifications:**
+ An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
+ 4+ years of experience in claims recovery and resolution
+ Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
+ Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
**Physical Requirements and Work Environment:**
+ Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_Optum is a drug-free workplace. © 2025 Optum Global Solutions (Philippines) Inc. All rights reserved._
This advertiser has chosen not to accept applicants from your region.

Claims Examiner

San Juan, La Union ₱300000 - ₱600000 Y Private Advertiser

Posted today

Job Viewed

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Job Description

Duties and Responsibilities

  • Receives and examines claims applications: Death, Disability, Killed-In-Action, Wounded-In-Action, Accident Hospitalization Benefits and other benefits of deceased members
  • Determines coverage and corresponding benefit of claims and computes individual shares of beneficiaries
  • Initiates suggestion and recommendation on claims with any legal issues to be resolved
  • Transmits disability and WIA claims to medical consultant for evaluation
  • Prepares claims disbursement vouchers and communication letters to claimants indicating claims settlement, computation benefit and completion of documents
  • Encodes claims transactions in database and scans documents for reference
  • Aids in communicating with beneficiaries regarding denied claims and claims with legal issues
  • Prepares report on claims with CLI and E56 insurance coverage
  • Handles claim register and prepares monthly claims register report
  • Answers queries regarding claims from walk-in members
  • Performs other related functions as directed by superior

Key Organizational Relationships

  • Reports directly to the Supervisor, Claims

Qualifications

  • Bachelor's degree in any business course
  • With a minimum of 1-year related experience and relevant technical trainings, preferably on signature verification and forgery detection etc.
  • Proficient in MS Office applications
  • Strong analytical, composition, and prioritizing skills
  • Detail-oriented and with good organization and coordination skills
  • Ability to maintain confidentiality
  • Good written and oral communication skills
This advertiser has chosen not to accept applicants from your region.

Claims Examiner

₱250000 - ₱500000 Y Chubb Insurance

Posted today

Job Viewed

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Job Description

ey Responsibilities:

  1. Process claims document and index to appropriate claims files in the system.

  2. Responsible for FNOL (First Notice of Loss)/ new claim files creation and registration in the system including policy verification/ upload of policy documents and determination of appropriate coverage.

  3. Ensures loss reserves are set and maintained with timely updates of claims data into our systems, ensuring correctness of systems and file records

  4. Review claim files and manage proper triage allocation:

  5. To appropriate Claims Work Queue by claims type and coverage

  6. To appropriate Claims Team by complexity (simple/ complex)
  7. To appropriate Claims Department (Complaints, Recovery, Fraud)

  8. Manage and assess claims (Fast Track, Within HFC Threshold, and Simple) from end to end including settlement in the system, responding to customer queries, providing updates, and requesting additional information as needed.

  9. Prepares and sends written correspondences (e.g. Acknowledgment, Settlement etc.) to brokers, claimants and others as required.

  10. Attend to claims enquiries and feedback, maintain positive relationship with all customers, brokers, providers etc.

  11. Handles incoming and outbound queries from Customers and/ or Brokers.

  12. Proactively apply claims policies and procedures including Chubb's policy in relation to fraud, salvage, recovery, cost containment and complaints.

  13. Attends administrative activities (team huddles, trainings)

  14. Performs other related duties as may be assigned by the supervisor/s

  15. Immediately report potentially and confirmed Fraudulent cases, Compliance and Privacy Breaches to Management chain.

  16. Nominate two process improvement ideas annually for SME and TL endorsement to the Manager.

Experience:

  • Good analytical skills and strong attention to detail.
  • Demonstrated strong communication skills (written and verbal) and interpersonal skills to be capable of dealing with all levels of Chubb personnel as well as claimants and brokers.
  • Ability to organize work effectively and methodically and as a team and adjust to change driven by business needs.
  • Ability to maintain a high level of quality in all claims administration activities ensuring the settlement times and complaint levels are minimized.
  • Sound knowledge of claims administration procedures and related systems.
  • Possess strong customer service behaviour.

  • Tertiary Qualified or minimum 2-3 years similar work experience

  • Claims Insurance background (is preferred)
This advertiser has chosen not to accept applicants from your region.
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Claims Examiner

₱900000 - ₱1200000 Y Combined Insurance

Posted today

Job Viewed

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Job Description

ey Responsibilities:

  1. Process claims document and index to appropriate claims files in the system.

  2. Responsible for FNOL (First Notice of Loss)/ new claim files creation and registration in the system including policy verification/ upload of policy documents and determination of appropriate coverage.

  3. Ensures loss reserves are set and maintained with timely updates of claims data into our systems, ensuring correctness of systems and file records

  4. Review claim files and manage proper triage allocation:

  5. To appropriate Claims Work Queue by claims type and coverage

  6. To appropriate Claims Team by complexity (simple/ complex)
  7. To appropriate Claims Department (Complaints, Recovery, Fraud)

  8. Manage and assess claims (Fast Track, Within HFC Threshold, and Simple) from end to end including settlement in the system, responding to customer queries, providing updates, and requesting additional information as needed.

  9. Prepares and sends written correspondences (e.g. Acknowledgment, Settlement etc.) to brokers, claimants and others as required.

  10. Attend to claims enquiries and feedback, maintain positive relationship with all customers, brokers, providers etc.

  11. Handles incoming and outbound queries from Customers and/ or Brokers.

  12. Proactively apply claims policies and procedures including Chubb's policy in relation to fraud, salvage, recovery, cost containment and complaints.

  13. Attends administrative activities (team huddles, trainings)

  14. Performs other related duties as may be assigned by the supervisor/s

  15. Immediately report potentially and confirmed Fraudulent cases, Compliance and Privacy Breaches to Management chain.

  16. Nominate two process improvement ideas annually for SME and TL endorsement to the Manager.

Experience:

  • Good analytical skills and strong attention to detail.
  • Demonstrated strong communication skills (written and verbal) and interpersonal skills to be capable of dealing with all levels of Chubb personnel as well as claimants and brokers.
  • Ability to organize work effectively and methodically and as a team and adjust to change driven by business needs.
  • Ability to maintain a high level of quality in all claims administration activities ensuring the settlement times and complaint levels are minimized.
  • Sound knowledge of claims administration procedures and related systems.
  • Possess strong customer service behaviour.
This advertiser has chosen not to accept applicants from your region.

Claims Examiner

₱250000 - ₱500000 Y Chubb Insurance

Posted today

Job Viewed

Tap Again To Close

Job Description

Role Purpose:

The primary purpose of this role is to produce a high quality Claims work through prompt and professional contact with customers and brokers. Manage and assess high frequency, simple/ low value claims through effective investigation, reserving and adjustment of claims incurred by insureds across Asia Pacific countries supported.

Key Responsibilities:

  1. Process claims document and index to appropriate claims files in the system.

  2. Responsible for FNOL (First Notice of Loss)/ new claim files creation and registration in the system including policy verification/ upload of policy documents and determination of appropriate coverage.

  3. Ensures loss reserves are set and maintained with timely updates of claims data into our systems, ensuring correctness of systems and file records

  4. Review claim files and manage proper triage allocation:

To appropriate Claims Work Queue by claims type and coverage

To appropriate Claims Team by complexity (simple/ complex)

To appropriate Claims Department (Complaints, Recovery, Fraud)

  1. Manage and assess claims (Fast Track, Within HFC Threshold, and Simple) from end to end including settlement in the system, responding to customer queries, providing updates, and requesting additional information as needed.

  2. Prepares and sends written correspondences (e.g. Acknowledgment, Settlement etc.) to brokers, claimants and others as required.

  3. Attend to claims enquiries and feedback, maintain positive relationship with all customers, brokers, providers etc.

  4. Handles incoming and outbound queries from Customers and/ or Brokers.

  5. Proactively apply claims policies and procedures including Chubb's policy in relation to fraud, salvage, recovery, cost containment and complaints.

  6. Attends administrative activities (team huddles, trainings)

11.Performs other related duties as may be assigned by the supervisor/s

  1. Immediately report potentially and confirmed Fraudulent cases, Compliance and Privacy Breaches to Management chain.

  2. Nominate two process improvement ideas annually for SME and TL endorsement to the Manager.

Experience:

  • Good analytical skills and strong attention to detail.
  • Demonstrated strong communication skills (written and verbal) and interpersonal skills to be capable of dealing with all levels of Chubb personnel as well as claimants and brokers.
  • Ability to organize work effectively and methodically and as a team and adjust to change driven by business needs.
  • Ability to maintain a high level of quality in all claims administration activities ensuring the settlement times and complaint levels are minimized.
  • Sound knowledge of claims administration procedures and related systems.
    Possess strong customer service behaviour.

Qualifications:

  • Tertiary Qualified or minimum 2-3 years similar work experience
    Claims Insurance background (is preferred)

Languages:

English = 3/5 and Filipino = 3/5

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

Claims Examiner

Mandaluyong, National Capital Region ₱40000 - ₱60000 Y Chubb Business Services

Posted today

Job Viewed

Tap Again To Close

Job Description

Role Purpose:

The primary purpose of this role is to produce a high quality Claims work through prompt and professional contact with customers and brokers.  Manage and assess high frequency, simple/ low value claims through effective investigation, reserving and adjustment of claims incurred by insureds across Asia Pacific countries supported.

Key Responsibilities:

  1. Process claims document and index to appropriate claims files in the system. 
  2. Responsible for FNOL (First Notice of Loss)/ new claim files creation and registration in the system including policy verification/ upload of policy documents and determination of appropriate coverage.
  3. Ensures loss reserves are set and maintained with timely updates of claims data into our systems, ensuring correctness of systems and file records
  4. Review claim files and manage proper triage allocation:

    • To appropriate Claims Work Queue by claims type and coverage

    • To appropriate Claims Team by complexity (simple/ complex)

    • To appropriate Claims Department (Complaints, Recovery, Fraud)
  5. Manage and assess claims (Fast Track, Within HFC Threshold, and Simple) from end to end including settlement in the system, responding to customer queries, providing updates, and requesting additional information as needed.
  6. Prepares and sends written correspondences (e.g. Acknowledgment, Settlement etc.) to brokers, claimants and others as required.

  7. Attend to claims enquiries and feedback, maintain positive relationship with all customers, brokers, providers etc. 

  8. Handles incoming and outbound queries from Customers and/ or Brokers.
  9. Proactively apply claims policies and procedures including Chubb's policy in relation to fraud, salvage, recovery, cost containment and complaints.
  10. Attends administrative activities (team huddles, trainings)
  11. Performs other related duties as may be assigned by the supervisor/s
  12. Immediately report potentially and confirmed Fraudulent cases, Compliance and Privacy Breaches to Management chain.
  13. Nominate two process improvement ideas annually for SME and TL endorsement to the Manager.

Experience:


• Good analytical skills and strong attention to detail.

• Demonstrated strong communication skills (written and verbal) and interpersonal skills to be capable of dealing with all levels of Chubb personnel as well as claimants and brokers. 

• Ability to organize work effectively and methodically and as a team and adjust to change driven by business needs. 

• Ability to maintain a high level of quality in all claims administration activities ensuring the settlement times and complaint levels are minimized.

• Sound knowledge of claims administration procedures and related systems.

• Possess strong customer service behaviour.

Qualifications:

• Tertiary Qualified or minimum 2-3 years similar work experience 

• Claims Insurance background (is preferred)

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

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