Claims Benefit Manager
Hive Health
Date: 3 weeks ago
City: Pasig City
Contract type: Full time
Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we’re on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we’d love to meet you!
About The Role
As the Claims Benefit Manager, you will lead Hive’s medical adjudication operations to ensure claims are reviewed accurately, efficiently, and in alignment with policies and regulatory standards. You’ll oversee a team of medical liaisons responsible for evaluating claims, managing provider coordination, and maintaining quality and compliance across the process.
This is both a strategic and hands-on leadership role. You’ll drive continuous process improvements, coordinate across departments such as Adjudication, Legal, and Provider Partnerships, and play a key part in shaping how Hive delivers fast, fair, and reliable claims experiences to its members and providers.
Responsibilities
Day 1 benefits for full-time employees – because we practice what we preach! Enjoy comprehensive healthcare coverage for you and your dependent, and paid time off from the start.
Grow with us – mentorship, career development, and learning opportunities to help you thrive.
Global connections – gain insights and support from top minds at Harvard, Stanford, and beyond.
About The Role
As the Claims Benefit Manager, you will lead Hive’s medical adjudication operations to ensure claims are reviewed accurately, efficiently, and in alignment with policies and regulatory standards. You’ll oversee a team of medical liaisons responsible for evaluating claims, managing provider coordination, and maintaining quality and compliance across the process.
This is both a strategic and hands-on leadership role. You’ll drive continuous process improvements, coordinate across departments such as Adjudication, Legal, and Provider Partnerships, and play a key part in shaping how Hive delivers fast, fair, and reliable claims experiences to its members and providers.
Responsibilities
- Lead and manage the medical liaisons team to meet accuracy, quality, and service targets
- Oversee daily adjudication operations to ensure claims are processed efficiently and in compliance with policy guidelines
- Conduct audits to ensure claims accuracy, completeness, and consistency with internal standards
- Identify potential cases of fraud, waste, or abuse (FWA) and coordinate investigations with Legal and Compliance
- Work cross-functionally with Claims, Provider Partnerships and Healthcare Services to address recurring operational issues
- Monitor key metrics such as turnaround time, quality scores, and error rates, and implement corrective measures as needed
- Drive continuous process improvements to enhance provider and member experience in the claims process
- Bachelor’s degree in nursing, healthcare management, business, or a related field
- At least 5 years of experience in operations, healthcare administration, or team management
- Strong analytical and problem-solving skills, with a focus on process improvement
- Experience leading teams and driving performance in fast-paced environments
- Comfortable working with data, reports, and digital systems to track metrics and quality outcomes
- Excellent communication and stakeholder management skills across both medical and non-medical teams
Day 1 benefits for full-time employees – because we practice what we preach! Enjoy comprehensive healthcare coverage for you and your dependent, and paid time off from the start.
Grow with us – mentorship, career development, and learning opportunities to help you thrive.
Global connections – gain insights and support from top minds at Harvard, Stanford, and beyond.
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
Employee Wellbeing Manager
Jollibee Group,
Pasig City
2 days ago
Title: Employee Wellbeing ManagerThe Employee Wellbeing Manager is responsible for developing, implementing, and managing comprehensive employee well-being strategies, focusing on mental health and initiatives to promote overall physical and social well-being and employee engagement initiatives for JFC Philippines. The role will manage and promote country-wide programs to provide support to employees in the following areas: Employee Assistance Programs, Volunteerism, Emergency...
Accounts Receivable Officer
MicroSourcing,
Pasig City
2 weeks ago
Discover your 100% YOU with MicroSourcing!Position: Accounts Receivable OfficerLocation: Cyberscape Beta, Ortigas, Pasig, PhilippinesWork setup & shift: Onsite | DayshiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonusesA Collaborative Spirit: Contribute to a positive and engaging work environment by participating...
Enterprise Risk Lead (Banking & Finance)
HR TechX Corp.,
Pasig City
2 weeks ago
Overview:We are seeking a seasoned risk professional to lead and strengthen our Enterprise Risk Management (ERM) initiatives. This role is pivotal in ensuring that frameworks, policies, and processes are robust, compliant with BSP regulations, and aligned with industry best practices. Reporting directly to the Chief Risk Officer, the position provides direct executive exposure and is designed for a strong leader...
