Office Staff

Job Purpose

This job is responsible for the review, analysis and/or adjudication of claims incurred by eligible members of PhilCare to ensure that they are according to respective benefits plan, policies and standards and maintain the records system for these claims.

Duties and Responsibilities

1. Claims Processing

Ensures accurate review of claims document like LOA, hospital bills/SOA, concurrent review form, physician's report, original OR for use in processing claims.

• Checks on completeness of received claims documents
• Reviews and match the endorsed document against ha actual encoded data in the system

2. Claims Review/ Evaluation/ Ajudication

Reviews/evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards

• Reviews, evaluates. checks and/or adjudicates claims against ABC, CQS and utilization and existing company policies and procedu...