HDSI: Medical Claim Adjudicator/Processor (6 months Project-based)

Job Objective / Purpose

The Claim Processors are responsible for timely processing of medical claims based on the member’s health benefit program. They analyze medical information, perform data entry, handle reimbursement claims, decide whether a claim should be covered or denied. Communicate issues or exceptions to other concerned departments as necessary.

This role will be hired under Flexicare, Health Delivery System, Inc. (HDSI) - a subsidiary of RelianceUnited

Duties And Responsibilities

• Provide claims support by reviewing, researching, investigating, processing and adjudicating claims.
• Authorize the appropriate payment or refer/escalate claims to concerned parties for further review.
• Adjudicate claims, analyze validity, and identify trends and provide reports if necessary.
• Communicate any discrepancy of claims.
• Consistently meets established productivity, schedule adherence, and quality standards.
• Suggest any process improvement ideas to the team lead that would greatly impact the process.
  
  

Background And Qualifications

• Candidates must possess at least a Bachelor's/College Degree in any field.
• Prior experience in claim reconciliation within the HMO or insurance industry is preferred.
• Ability to do on-site visits and extend beyond company operating hours when needed.
• Good communication and critical thinking skills.
• Knowledgeable of Google platforms such as but not limited to GDocs, GSheets, etc. and MS Office.
• Ability to handle multiple tasks, in a timely manner, on a continual basis under strict deadlines.
• Strong planning, organization, and follow-up skills.
• Proven ability to work independently and as a team member
• Adheres consistently to the company values
  
  

Work Conditions

• Employment type: 6 months Project-based
• Onsite work set up
• Work Schedule: Mondays-Fridays, 8:00AM - 5:00PM
• Assigned in Greenfield District, Mandaluyong City
  
  

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Visit The RelianceUnited Website Here

https://www.relianceunited.com/

What It's Like To Work At RelianceUnited

https://www.relianceunited.com/careers

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Pursuant to the Data Privacy Act of 2012 (R.A. 10173), its Implementing Rules and Regulations, and other issuances of the National Privacy Commission, the RelianceCare Inc., OR it’s subsidiary or affiliate, such as ActiveOne Health, Inc., and Health Delivery Systems, Inc. (also doing business under the name and style of “Flexicare Benefit Solutions and Healthfirst Clinic”), whichever is applicable to this form, ("It" or "the Company", for brevity) commits to protect and keep the confidentiality, integrity, and availability of all personal data provided. It will only use personal information to process job applications. Any questions regarding the Company's privacy notice shall be coursed through Its Data Protection Officer at the following and applicable email addresses: RCI - [email protected], ActiveOne - [email protected], or HDSI - [email protected]

I have read and understood the above Notice and hereby give my consent to collect and process my personal data.*