164 Healthcare Claims jobs in the Philippines

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

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.

• 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

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

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.

• 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.

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

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

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)

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.

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.

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

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