Medical Reimbursement Officer
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Job Description
ONLY FILIPINO NATIONALS NEED APPLY
Job Purpose:
We are looking for a qualified Officer to join our medical reimbursement team. The role involves reviewing and processing reimbursement claims for medical services ensuring they are clinically justified supported by valid documentation and compliant with the table of benefits and health protocols. The ideal candidate will collaborate with brokers clients and internal teams to ensure timely accurate and customer-focused decisions.
Key Responsibilities:
- Review and process medical reimbursement claims for accuracy eligibility and clinical validity.
- Verify supporting documents (invoices prescriptions reports) to ensure compliance with policy and benefits.
- Ensure adherence to insurance regulations internal protocols and medical guidelines.
- Coordinate with brokers clients and policyholders to clarify or obtain required documentation.
- Identify and escalate fraudulent abnormal or non-compliant cases.
- Provide recommendations for claim approvals or rejections based on evidence.
- Work with Finance and Claims teams to ensure timely settlement of approved claims.
- Handle claim disputes fairly and in line with company policies.
Educational Qualifications:
Bachelors degree in Allopathic medicine health science Pharmacy Physiotherapy Nursing Dentistry or a related medical/paramedical field.
Experience:
Minimum 2 years of relevant experience in the medical field insurance claims or reimbursement function.
Key Skills:
- Solid knowledge of medical treatments and terminology.
- Strong ability to review reimbursement documents and medical records.
- Clear communication skills for dealing with brokers clients and policyholders.
- High accuracy and attention to detail in claim evaluation.
- Sound judgment in handling complex cases.
- Ability to analyze trends and detect claim irregularities.
Employment Type
Full Time
