Overview

As the Health Claims LO you will be assigned to different hospitals across the county and provide a range of support services to our health clients across Metro Manila, Metro Cebu & Davao areas. The role centers on customer/client management to achieve integrated care outcomes for hospitalized clients.

Responsibilities

• Assessment / adjudication of “real-time” hospitalization claims of Insured member (i.e currently hospitalized customers
• Analysis of medical documents related to the hospitalization of Insured customer to come up with the correct claims decision.
• Approve amounts (up to P500K) and ensure proper escalations are done for those claim amount beyond their limit.
• Effectively communicating the benefits of the health insurance plan to the customer and to the agents both verbally and in writing
• Ensuring proper case management is conducted to ensure seamless health customer journey for hospitali...