Medical Claims Specialist

Make a difference and advance your career with Chong Hua Hospital, the Philippines' premier healthcare destination!?✨

S/he determines whether the denied claims are for appeal, thus, prepares an appeal letter. Moreover, s/he prepares preliminary assessment of patient’s chart pertaining to PhilHealth Insurance Corporation request for a verified letter.

One of her/his essential roles is to train the Consultant and Resident Doctors on PhilHealth concepts and rules. S/he is also expected to assist in planning and executing claims improvement initiatives and submit timely and accurate reports of medical claims.

• Review medical claims to ensure company reimbursement payments are accurate and reprice claims according to hospital payment schedules and reimbursements.
• Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable.
• Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims.
• Responsible for creating timely and accurate reports on medical claims and appeals.

• Must be a licensed Physician.
• Relevant work experience in medical field and with background in claims management
• Healthcare industry experience is a plus.
• Comprehensive knowledge of insurance plans, member eligibility, and medical billing
• Strong background in government and commercial payers
• Understands medical terminologies
• Demonstrated understanding of basic corporate office software, including Microsoft Office 365 applications.
• Excellent communication skills. Proficiency in the Visayan dialect and/or Tagalog is required.