Medical Risk Specialist
Nestlé
Date: 4 hours ago
City: Meycauayan
Contract type: Full time
Location: Meycauayan, Bulacan, PH
Company: Nestlé Integrated Business Services Manila, Inc.
Job Type: Full Time
Education: Bachelor’s Degree (Medical-related course preferred)
Experience: At least 2+ years of experience in medical, healthcare, or BPO environment
Joining Nestlé means being part of the largest food and beverage company in the world, driven by a purpose to enhance quality of life and contribute to a healthier future.
Nestlé Integrated Business Services Manila, Inc. delivers world-class business support across global markets, with a strong focus on accuracy, efficiency, and service excellence.
Position Summary
As a Medical Risk Specialist, you will support the delivery of medical insurance and risk management services across markets. You will play a critical role in medical claims processing, insurance analysis, and stakeholder coordination, ensuring accuracy, compliance, and timely resolution of insurance-related activities.
You will collaborate closely with Group Risk Services (GRS), Total Rewards, and external insurance providers to drive operational excellence and continuous improvements in medical insurance processes.
A Day in the Life
Company: Nestlé Integrated Business Services Manila, Inc.
Job Type: Full Time
Education: Bachelor’s Degree (Medical-related course preferred)
Experience: At least 2+ years of experience in medical, healthcare, or BPO environment
Joining Nestlé means being part of the largest food and beverage company in the world, driven by a purpose to enhance quality of life and contribute to a healthier future.
Nestlé Integrated Business Services Manila, Inc. delivers world-class business support across global markets, with a strong focus on accuracy, efficiency, and service excellence.
Position Summary
As a Medical Risk Specialist, you will support the delivery of medical insurance and risk management services across markets. You will play a critical role in medical claims processing, insurance analysis, and stakeholder coordination, ensuring accuracy, compliance, and timely resolution of insurance-related activities.
You will collaborate closely with Group Risk Services (GRS), Total Rewards, and external insurance providers to drive operational excellence and continuous improvements in medical insurance processes.
A Day in the Life
- Analyze medical claims, billing, and coding data to ensure accuracy and completeness of insurance processes
- Manage and process medical insurance claims, including validation, documentation, and follow-ups with insurers
- Coordinate with internal stakeholders and external partners (insurers, brokers, third-party administrators) to resolve issues and escalations
- Maintain and validate employee census data aligned with insurance policies and agreements
- Prepare reports on claims utilization, trends, and risk insights to support decision-making
- Support governance, compliance, and internal control activities in relation to medical insurance
- Drive process improvements and automation initiatives to enhance efficiency and service delivery
- Conduct regular reviews, stakeholder discussions, and knowledge-sharing sessions
- Ensure accurate and timely claims processing and reporting
- Manage and resolve insurance-related queries and escalations
- Maintain high-quality medical data management standards
- Support risk analysis, compliance, and governance frameworks
- Deliver insights through data analysis and reporting
- Contribute to continuous improvement and stakeholder satisfaction
- Bachelor’s degree in Nursing, Medical Technology, Psychology, or related field
- Minimum of 2 years’ experience in healthcare, medical insurance, or BPO setting
- Knowledge of medical insurance processes, claims handling, and coding
- Proficiency in MS Office (Excel, Word) and familiarity with SAP systems
- Experience in data analysis, reporting, and database management
- Understanding of risk management, compliance, and internal controls
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