• Process claims by reviewing, researching, investigating, and adjudicating claims.
• Authorize the appropriate payment or refer/escalate claims to concerned parties for further review.
• Adjudicate claims, analyze validity, identify trends, and provide reports if necessary.
• Communicate any discrepancy of claims.
• Consistently meets established productivity, schedule adherence, and quality standards. Suggest any process improvement ideas to the team lead that would greatly impact the process.
• Attend any developmental training for career and personal development.

Background and Qualifications:

• Candidates must possess at least a bachelor's/college degree in any field.
• Prior experience in claim reconciliation within the HMO or insurance industry is preferred.
• Ability to do on-site visits and extend beyond company operating hours when needed.
• Good communication and critical thinking skills.
• Knowledgeable of Google platforms such as, but not limited to, GDocs, GSheets, etc., and MS Office.
• Ability to handle multiple tasks in a timely manner on a continual basis under strict deadlines.
• Strong planning, organization, and follow-up skills.
• Proven ability to work independently and as a team member
• Adheres consistently to the company values

• Onsite work setup
• Work Schedule: Mondays-Fridays, 8:00AM - 5:00PM
• Assigned in Greenfield District, Mandaluyong City
• Occasional travel to build partnerships with institutions and organizations may be expected, as well as attendance at relevant conferences and events