Medical Adjudicator
The Manufacturers Life Insurance Company
Quezon City, PH
5d ago

Job Description :

Are you looking for unlimited opportunities to develop and succeed? With work that challenges and makes a difference, within a flexible and supportive environment, we can help our customers achieve their dreams and aspirations.

Job Description

The Operations department for claims processing is responsible in claims adjudication, receiving and ensuring that the clients’ need are well taken cared of.

The job purpose is to ensure that the processors are able to meet individual and team goals in line with the Service Level Agreement (SLA).

Eligibility Requirements : (if internal application)

  • Open to all MBPS Associates with one year tenure in their current position.
  • Candidate must meet the qualifications of the position.
  • Candidate must meet job expectations and pass all performance metrics in his / her current unit.
  • Candidate should not have any attendance issues or any disciplinary action.
  • Key Accountabilities :

  • Process and capture information to system according to established methods and procedures
  • Handles inpatient claims worldwide (mainly from Hong Kong, Macau and Mainland China)
  • Issues decline / follow-up to the clients for outstanding information and clarifications
  • Practice good judgment in approving, make necessary recommendation and declining medical claims of clients
  • Consistently attain the service level set by the Company
  • Assist colleagues and other teams in their production work upon request
  • Setup cases and identify discrepancies and irregularities during processing
  • Suggest ways on how to improve the current process and team metrics
  • Handle multiple tasks in a fast-paced environment
  • Constantly increase the number of knowledgeable functions handled by the team
  • Such other duties and functions as assigned by Supervisor
  • Minimum Skills Requirement to Hire :

    Minimum Qualifications :

  • Completed a Bachelor’s Degree in related field
  • Pass the Chinese Exam Score with at least 61-75 out of 100 items
  • Qualifications :

  • Medical knowledge
  • Basic life insurance concept such as LOMA 280
  • Knowledge in claims processing
  • Technical Skills

  • Minimum keyboard typing skills of 32 words per minute
  • Ability to use desktop computer system
  • Lotus Notes knowledge
  • Knowledge of MS Applications (Word, Excel & MS Powerpoint)
  • Soft Skills

  • Chinese literate including reading comprehension and typing (this is already indicated and will be verified in minimum qualifications)
  • Good written and verbal communication skills (English & Chinese)
  • Ability to express ideas clearly and concisely in writing letters to clients and agents
  • Apply
    Add to favorites
    Remove from favorites
    My Email
    By clicking on "Continue", I give neuvoo consent to process my data and to send me email alerts, as detailed in neuvoo's Privacy Policy . I may withdraw my consent or unsubscribe at any time.
    Application form