Claims Staff
Cooperative Health Management Federation Quezon City Full-time
Qualifications
- Must be a graduate of any medical-related course (e.g., Nursing, Medical Technology, Biology, or equivalent).
- or at least with experience in HMO or health insurance claims (advantage but not required)
- Good attention to detail and analytical skills.
- Effective communication and coordination skills.
- Proficient in basic computer applications and documentation.
- Review insurance claims for accuracy, completeness, and compliance with policy provisions.
- Verify policy details, member eligibility, and coverage inclusions/exclusions.
- Investigate claims by gathering and validating necessary information from claimants, healthcare providers, and other relevant parties.
- Evaluate claims in accordance with company policies and determine the extent of liability.
- Process approved claims, payments, and settlements in a timely and accurate manner.
- Communicate with claimants, policyholders, healthcare providers, and internal stakeholders to provide claim status updates and resolve concerns.
- Maintain accurate and up-to-date records of claims and related documentation.
- Perform other ad hoc tasks as may be assigned by the immediate superior.
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