Responsibilities:

• Adjudicates claim
• Initiates or conducts investigations of questionable claims
• Resolves claims by approving or denying, calculating benefits due, initiating payment, preparing notice to member after case adjudication by indicating remarks in the system
• Documentations of the medical claims by preparing worksheets for inpatient cases, data entry in the system, reports, logs, and records
• Maintains quality services by following client service practices and responding to customer inquiries
• Performs second-layer checking of claims proposed by junior assessors
• Handles specific portfolios with specific service agreement

Qualifications:

• Bachelor’s degree in a medical-related field is an advantage
• At least 4 years of relevant experience in the Healthcare, Insurance, or BPO industry
• Excellent verbal and written communication skills
• Proficient in Windows OS, MS Office applications
• Has a Knowledge of medical and insurance terminologies
• Has critical thinking skills with a focus on issue resolution and customer satisfaction
• Can multitask and has a high attention to details