Claims Processor  

Responsible for the evaluation and prompt processing of claims, accurate transmittal of checks to our clients, complete and timely transmittal of billback claims, and maintenance of complete and updated claims records.

Responsibilities:

• Implements and maintains negotiation discounts.
• Accurately assesses and computes claims within tha account's coverage limit and benefit.
• Builds good relationships with clients, co-workers and superiors, and ensures quick and effective responses to problems/ queries.
• Attends to visits and queries of all accredited providers.
• Effectively handles feedbacks and concerns coming from our members, brokers, agents and HR through phone calls and emails.
• Handles claims payment within turn-around time.
• Provides clients with accurate data and quality services.
• Sorts and logs received claims from providers, brokers and individual members.
• Encodes and Updates claims data and their statuses in the claims monitoring summary.
• Evaluates claims received with regards to completeness of documents/ details as well as the necessity and reasonableness of payment.
• Analyzes, denies and approves all claims related documents based on account's schedule of benefits, or if there are any lacking documents.
• Drafts letter for clients pertaining to claims submittal.
• Processes claims and releasing of check payments within the turn-around time.
• Ensures complete, accurate and timely transmittal of processed claims with billback/collectible charges.
• Files all regular claim documents, its transmittals and ORs.
• Conducts reconciliation with accredited providers.
• Ensures accurate transmittal of withholding tax to accredited providers.

• Medical Allied course Graduate.
• Good Communication skills.
• Customer-oriented.
• Good problem solving skills.