Qualifications
- Preferably a graduate of any medical or allied medical degree.
- At least **2 yrs experience in life, health and medical claims adjudication.
**:
- Required**: 2 years experience in Death Claims processing**
- Excellent written and oral communication skills with the ability to effectively articulate life insurance terms and conditions as well as the convey the reason for claims decision.
- Detail oriented and highly organized.
Team player and at the same time efficiently do tasks in silo.
- Above average level of knowledge in insurance operational processes.
- Customer centric and must advocate the Customer First mindset.
- Highly developed sense of integrity.
- Pleasant, patient and friendly attitude; sociable personality.
Able to relate to work colleagues from different backgrounds.
- Good negotiation and influencing skills.
- Background in death claim processing
- Directly responsible for the adjudication and approval of death, critical illness, TPD, hospitalization benefit of all individual and group insurance claims within his/her approval limit and within the agreed turnaround time.
- Ensures that the life claims benefits are paid out in accordance with existing Philippine life insurance laws and statute.
- Assist in the resolution of complex claims cases and formulation of appropriate claims recommendation or decision where technical claims knowledge is required.
- Proactively manage and ensure timely resolution of customer and distributor claims-related issues including those raised in customer-specific platforms such as SCRM and AXA Angels.
- Ensure that life claims-related communications being sent to the internal and external stakeholders are appropriate and timely.
Assist in regular updates of claims communications templates to ensure robust and dynamic claims communications across all platforms.
- Seamlessly coordinate with Claims Handler/Admin for the different processes which requires the role of the Claims Handler/Admin
- Research required information using available resources.
as well as Handle, manage, and resolve customer complaints.
- Following up on complicated customer calls where required.
- Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.
- Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests.
Escalate where necessary in accordance with claims guidelines and procedures.
- Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.
- Provide backup for any support functions in the office.
- Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.
- Accomplishes company goals by taking ownership of work responsibilities and constantly identify opportunities for work process improvement.
- Ensure legal compliance by following company policies, procedures, guidelines ad well as local insurance regulations and statute.
- Adhere to strict data protection compliance by keeping claims and sensitive medical information highly confidential.
- Promptly answer inbound calls from customers/distributors/providers who are looking to get a pre-approval for an availment/claim on a health policy.
- Accurately determine if a medical condition is a covered benefit based on the policy provisions, terms, and conditions.
- Seamlessly coordinate with Claims Handler/Admin for the different processes which requires the role of the Claims Handler/Admin
- Research required information using available resources.
as well as Handle, manage, and resolve customer complaints.
- Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.
- Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests.
Escalate where necessary in accordance with claims guidelines and procedures.
- Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.
- Provide backup for any support functions in the office.
- Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.
- Ensure legal compliance by following company policies, procedures, guidelines ad well as local insurance regulations and statute.
- Adhere to strict data protection compliance by keeping claims and sensitive medical information highly confidential.
**Job Types**: Full-time, Permanent, Fixed term
**Salary**: Php20,000.00 - Php25,000.00 per month
Application Question(s):
- Are you amenable to work on site in Makati City?
- Do you have an experience in processing Death Insurance claims?
How long?
- Do you have an experience in processing Life Insurance claims?
How long?
- Are you open for Full time project-based employment?
(Our client is Open for Absorption or contract renewal; They offer good benefits)
**Education**:
- Bachelor's (preferred)