Medical Claims 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

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
  • Qualifications :

  • Medical knowledge
  • 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
  • Behavioral Competency

  • Good organization and analytical skills
  • Willing to render overtime work as needed
  • Flexible and adaptable to change
  • Proven ability to balance approach in different levels of transactions
  • Willingness to experiment and take risks
  • Can handle multiple tasks in a fast-paced environment
  • Proficient in handling all the work and processes assigned
  • Always on time to work / meetings and is not sickly
  • Accountable for one's actions
  • Compliance-minded
  • Demonstrates initiative to improve
  • Open for team collaboration
  • Extra-miler and constantly pushes the limits of current responsibilities
  • Has a positive attitude towards accepting additional challenges and new assignments
  • Customer-centric and service oriented
  • Actively pursues personal and professional development opportunities
  • Fast learner
  • Minimum Skills Requirement to Go Live

  • Must have all Minimum Skills Required to Hire
  • Product Specific KnowledgeUnderstand all type of Hospital Benefit offered by Manulife International Limited Individual Financial ProductsProduct restrictions and eligibilityProduct specific mechanicsPass the following exercises : Prefix Suffix, Abbreviations, Bilingual Diagnosis, Bilingual -
  • Hospital Charges, Diagnosis Reading & BPO Testing with a score of 80%

  • Process Specific KnowledgeKnowledge of evaluating application forms, claim history, inforce period, attending physician statement with the ability to making sound assessmentAbility to understand the logic of pre existing conditions, non disclosures & exclusions within every claim assessedBe able to provide sound decisions whether to proceed investigation / s, decline, approve or to re-
  • route to underwriting the claim cases handled

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