job description
Are you a detail-oriented professional looking to build a career in the insurance industry? Cocolife, one of the leading insurance providers in the Philippines, is currently seeking a highly motivated HMO Claims Associate to join our dynamic team in Makati City. In this role, you will play a critical part in our mission to provide excellent service to our members by ensuring the accurate, efficient, and timely processing of medical claims.
As an HMO Claims Associate, you will be the backbone of our health maintenance operations. You will be responsible for reviewing medical documents, verifying coverage eligibility, and ensuring that all claims adhere to company policies and health insurance regulations. This position is perfect for someone who thrives in a fast-paced environment, possesses strong analytical skills, and is dedicated to delivering superior customer service. If you are looking for a stable career with opportunities for professional growth within a reputable organization, we want to hear from you.
Responsibility
- Evaluate and process health insurance claims in accordance with company guidelines and HMO policies.
- Verify patient eligibility and ensure all supporting medical documentation is complete and accurate.
- Coordinate with healthcare providers and facilities to resolve claim discrepancies or missing information.
- Maintain a high level of accuracy and productivity in processing daily claim volumes.
- Monitor and track pending claims, ensuring timely follow-up and resolution.
- Adhere to strict data privacy and confidentiality standards regarding member medical records.
- Provide clear and professional communication to internal departments regarding claim statuses.
Qualifications
- Bachelor’s degree in Nursing, Medical Technology, Pharmacy, Health Administration, or a related field.
- Previous experience in medical claims processing or an HMO environment is highly preferred, but fresh graduates are welcome to apply.
- Strong knowledge of medical terminology and standard coding procedures.
- Excellent attention to detail and ability to perform repetitive tasks with high precision.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
- Strong communication skills, both verbal and written, in English and Filipino.
- Ability to work independently as well as collaboratively within a team.