• Assure accurate insurance claims adjudication in a timely manner.
• Assure timely submission of invoices/claims utilization report.
• Validate documents received as well as members' information to adjudicate the claims based on the submitted information.
• Apply the Plan policy and its exclusion as well as underwriting guidelines to determine coverage for claims.
• Deny claims according to SOB, exclusions, and policies.
• Assure timely payment of invoices from providers and ensure all information and documents needed are accurate and complete.
• Keep management aware of members' issues from providers to enhance operations and escalate to the higher-ups when necessary.
• Coordinate with providers all Claims unpaid and do reconciliation.
• Answer inquiries and handle complaints from providers.

Top Benefits or Perks:

• The country's best medical coverage for you and your family, with an annual limit of 100,000 USD (almost 6,000,000 PHP) per insured member.
• Profit sharing (0-4 months extra salary per year performance-based—potential of 100K).
• Flexible hybrid work set-up (1-10 days in the office per month).
• Subsidized mobile plan (1,000 PHP).
• Internet allowance (1,000 PHP).
• 1-time 20,000 PHP allowance for home office set-up.

• Bachelor's degree in nursing or related course.
• Registered Nurse is an advantage.
• Thorough knowledge of the claims process in medical insurance with a minimum of 1 year of relevant experience.
• Structured and organized.
• Good oral and written English communication skills.