Claims Processing Specialist Dental Adjudicator
StayWell Information Systems, Inc.
- Quezon City, Metro Manila
- Permanent
- Full-time
- Review and evaluate data on claim forms and supporting documents.
- Process for payment on- and off-island medical, dental, and pharmacy claims
- Review and verify authorized charges on claim statements.
- Prepare correspondence to providers regarding billing issues and benefit coverage.
- Handle data entry of medical, dental and pharmacy claims into the computer for processing.
- Re-evaluate evidence and obtain additional information in connection with claims pended, denied or under appeal.
- Ensure that all claims and payments are reconciled.
- Coordinate daily activities, including handling of complaints, with various departments such as enrollment and customer care.
- Ensure participation to various company programs, activities and committees, such as but not limited to training and development programs, collegial planning, collaborative ad-hoc projects, and other company-sponsored events, as necessary;
- Adhere to all set Organization policies, procedures and standards, and promote culture of compliance and continuous improvement among the existing manpower pool.
- Adhere to all policies, procedures and standards set by the company, and help promote the culture of compliance and continuous improvement within the Organization.
- Perform job functions consistent with the company's vision and mission statements, and core values.
- Perform other duties, roles and responsibilities analogous, related, similar, germane and/or implied to the above-mentioned.
- Graduate of Dentistry ( or taken DMD program), possess Bachelor’s degree in Nursing, Pharmacy or any allied medical field
- At least one (1) year of work experience in health insurances
- Computer literate, preferably with working knowledge in using MS Office Suite (Word, Excel, PPT, etc.)
- Knowledge on basic medical terminology
- Knowledge in claims procedures
- Ability to solve basic claim issues and concerns
- Basic business communication skills
- Knowledge of basic accounting principles
- Retirement Benefit Plans
- Special Leave Benefits for Women
- Single Parent Leave
- Paid Holidays
- Medical / Health Insurance
- Paid Sick Leave
- Paid Bereavement/Family Leave
- Life Insurance
- Paid Vacation Leave
- Maternity & Paternity Leave
- Medical, Prescription, Dental, or Vision Plans
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