Job Description

QUALIFICATIONS:

• Preferably a graduate of any medical or allied medical degree.
• At least 2 yrs experience in life, Death, health and medical claims adjudication
• Excellent written and oral communication skills with the ability to effectively articulate life insurance terms and conditions as well as the convey the reason for claims decision
• Detail oriented and highly organized. Team player and at the same time efficiently do tasks in silo.
• Above average level of knowledge in insurance operational processes.
• Customer centric and must advocate the Customer First mindset.
• Highly developed sense of integrity.
• Pleasant, patient and friendly attitude; sociable personality. Able to relate to work colleagues from different backgrounds
• Good negotiation and influencing skills

:

• Directly responsible for the adjudication and approval of death, critical illness, TPD, hospitalization benefit of all individual and group insurance claims within his/her approval limit and within the agreed turnaround time.
• Ensures that the life claims benefits are paid out in accordance with existing Philippine life insurance laws and statute.
• Assist in the resolution of complex claims cases and formulation of appropriate claims recommendation or decision where technical claims knowledge is required.
• Proactively manage and ensure timely resolution of customer and distributor claims-related issues including those raised in customer-specific platforms such as SCRM an
• Ensure that life claims-related communications being sent to the internal and external stakeholders are appropriate and timely. Assist in regular updates of claims communications templates to ensure robust and dynamic claims communications across all platforms.
• Seamlessly coordinate with Claims Handler/Admin for the different processes which requires the role of the Claims Handler/Admin
• Research required information using available resources. as well as Handle, manage and resolve customer complaints
• Following up on complicated customer calls where required.
• Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.
• Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests. Escalate where necessary in accordance with claims guidelines and procedures.
• Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.
• Provide backup for any support functions in the office.
• Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.

Job Types: Full-time, Permanent, Fixed termSalary: Php17,000.00 - Php25,000.00 per monthApplication Question(s):

• Are you amenable to work on site in Makati City?
• * Are you open for Full time project-based employment (Our client is Open for Absorption or contract renewal? They offer good benefits)
• Do you have an experience in processing Life Insurance Claims?
• Do you have an experience in processing Death Insurance Claims?

Education:

• Bachelor's (Preferred)